Individual provider Active NPI

Tazneen Ittaka Chowdhury, NP

  • Psychiatric/Mental Health Nurse Practitioner
  • Long Island City, NY
National Provider Identifier
1700445020
Registry record updated Oct 5, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
F402538-1 Issued in NY
Practice address
2976 Northern Blvd FL 2
Long Island City, NY 11101-2829
Phone
(862) 264-7291
NPI assigned
Jun 11, 2019
Last updated
Oct 5, 2022By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 5, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric/Mental Health Nurse Practitioner 363LP0808X F402538-1 NY Primary

Addresses

Primary practice location

2976 Northern Blvd FL 2
Long Island City, NY 11101-2829

Mailing address

2976 Northern Blvd FL 2
Long Island City, NY 11101-2829
Phone (862) 264-7291

Other practice location 1

111 E 210th St
Bronx, NY 10467-2401
Phone (718) 920-2290

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20190925002792 NY Practitioner - Nurse Practitioner 6204166754 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

2090 Adam Clayton Powell Jr Blvd
FL 4
New York, NY 10027-4941
Phone (212) 553-6751

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Montefiore Medical Center CurrentSince Aug 16, 2019 Accepting new patients
Montefiore Medical Center CurrentSince Aug 16, 2019 Accepting new patients
The Fortune Society Inc. CurrentSince Oct 4, 2022 Accepting new patients
Center for Alternative Sentencing and Employment Services CurrentSince May 8, 2025 Accepting new patients

Locations

111 E 210th St
Bronx, NY 10467

151 Lawrence St
Fl 3
Brooklyn, NY 11201
Phone (212) 553-6300

2976 Northern Blvd
Fl 2
Long Island City, NY 11101
Phone (212) 691-7554

2090 Adam Clayton Powell Jr Blvd
Fl 4
New York, NY 10027
Phone (212) 553-6708

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1560211200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1664928000000",
    "number": "1700445020",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2976 NORTHERN BLVD FL 2",
            "city": "LONG ISLAND CITY",
            "state": "NY",
            "postal_code": "111012829",
            "telephone_number": "862-264-7291"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2976 NORTHERN BLVD FL 2",
            "city": "LONG ISLAND CITY",
            "state": "NY",
            "postal_code": "111012829",
            "telephone_number": "862-264-7291"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "111 E 210th St",
            "address_purpose": "LOCATION",
            "city": "Bronx",
            "state": "NY",
            "postal_code": "104672401",
            "country_code": "US",
            "telephone_number": "718-920-2290",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CHOWDHURY",
        "first_name": "TAZNEEN",
        "middle_name": "ITTAKA",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-06-11",
        "last_updated": "2022-10-05",
        "certification_date": "2022-10-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "NY",
            "license": "F402538-1",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Long Island City, NY

Sources for this page

Verify at the official NPI Registry.