Active NPI
Jerry Tan, MS, RD, CDN
- Registered Dietitian
- New York, NY
National Provider Identifier
1548857519
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- 86063459
- Practice address
- 299 Broome St Apt 9
New York, NY 10002-3729 - Phone
- (917) 781-5767
- NPI assigned
- Dec 24, 2020
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Dietitian | 133V00000X | 86063459 | NY | Primary |
Addresses
Primary practice location
299 Broome St Apt 9
New York, NY 10002-3729
Mailing address
299 Broome St Apt 9
New York, NY 10002-3729
Phone (917) 781-5767
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 86063459 | NY | MD | Registered Dietitian |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1608768000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1609113600000",
"number": "1548857519",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "299 BROOME ST APT 9",
"city": "NEW YORK",
"state": "NY",
"postal_code": "100023729",
"telephone_number": "917-781-5767"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "299 BROOME ST APT 9",
"city": "NEW YORK",
"state": "NY",
"postal_code": "100023729",
"telephone_number": "917-781-5767"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TAN",
"first_name": "JERRY",
"credential": "MS, RD, CDN",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2020-12-24",
"last_updated": "2020-12-28",
"certification_date": "2020-12-28",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "NY",
"license": "86063459",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in New York, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 28, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.