Active NPI
Renee Anderson
- Administrator Registered Nurse
- Flushing, NY
National Provider Identifier
1710359062
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Administrator Registered Nurse
- License
- 406843-1
- Practice address
- 14202 20TH Ave
Flushing, NY 11351-3000 - Phone
- (917) 563-3350
- Fax
- (646) 829-1363
- NPI assigned
- Oct 27, 2015
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Administrator Registered Nurse | 163WA2000X | 406843-1 | NY | Primary |
Addresses
Primary practice location
14202 20TH Ave
Flushing, NY 11351-3000
Mailing address
52 Smith LN
Medford, NY 11763-1128
Phone (631) 835-1630
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 406843-1 | NY | MD | Administrator Registered Nurse |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1445904000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1445904000000",
"number": "1710359062",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "52 SMITH LN",
"city": "MEDFORD",
"state": "NY",
"postal_code": "117631128",
"telephone_number": "631-835-1630"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "14202 20TH AVE",
"city": "FLUSHING",
"state": "NY",
"postal_code": "113513000",
"telephone_number": "917-563-3350",
"fax_number": "646-829-1363"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ANDERSON",
"first_name": "RENEE",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2015-10-27",
"last_updated": "2015-10-27",
"status": "A"
},
"taxonomies": [
{
"code": "163WA2000X",
"taxonomy_group": "",
"desc": "Registered Nurse, Administrator",
"state": "NY",
"license": "406843-1",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Flushing, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 27, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.