Tara Marie Vanderburg
Physician Assistant

Address: 611 Northern Blvd, Suite 200, Great Neck, NY 11021-5207
Phone: 5167232663

Tara Marie Vanderburg (NPI# 1386085082) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider Identifier (NPI) 1386085082
Entity Type Individual
Full Name Tara Marie Vanderburg
Credential PA-C
Gender Female
Practice Address 611 Northern Blvd
Suite 200
Great Neck
NY 11021-5207
Practice Telephone 5167232663
Mailing Address 611 Northern Blvd
Suite 200
Great Neck
NY 11021-5207
Sole Proprietor Yes, this individual is a Sole Proprietor
Enumeration Date 2013-07-10
Last Update Date 2016-08-04

Taxonomy Codes

Primary Taxonomy Classification Taxonomy Group License Number State
Yes 363A00000X Physician Assistant Physician Assistants & Advanced Practice Nursing Providers 016642 NY

Physician Overview

NPI 1386085082
PAC ID by PECOS 2668770108
Professional Enrollment ID I20160415001449
Full Name Tara M Vanderburg
Organization Legal Name NORTH SHORE-LIJ MEDICAL PC
Phone Number 5167232663
Gender F
Graduation Year 2013
Primary Specialty PHYSICIAN ASSISTANT
Group Practice PAC ID 3375701568
Number of Group Practice Members 2597
Accepts Medicare Assignment Y

Claims Based Hospital Affiliation

Claim Control Number (CCN) Legal Business Name
330106 NS/LIJ HS-NORTH SHORE UNIVERSITY HOSPITAL AT MANHASSET

Office Location

Street Address 611 NORTHERN BLVD
SUITE 200
City GREAT NECK
State NY
Zip Code 11021-5207

Providers in the same location

NPI Name Taxonomy Address Enumeration
1598739989 Thomas Michael Mauri Orthopaedic Surgery 611 Northern Blvd, Suite 200, Great Neck, NY 11021-5207 2006-02-14
1740637362 Yael Cukier Clinical Neuropsychologist 611 Northern Blvd, Suite 150, Great Neck, NY 11021-5207 2016-05-24
1811356082 Sheila Manzoor Physician Assistant 611 Northern Blvd, Suite 200, Great Neck, NY 11021-5207 2016-02-16
1083070320 Richard T Miller Dmd PC Dentist 611 Northern Blvd, Great Neck, NY 11021-5207 2015-12-31
1104207190 Kelly Janke Clinical Neuropsychologist 611 Northern Blvd, Suite 150, Great Neck, NY 11021-5207 2015-06-15
1891082632 Luca Giliberto Psychiatry & Neurology 611 Northern Blvd, Ste 150, North Shore-lij-cushing Neuroscience Institute, Great Neck, NY 11021-5207 2011-06-30
1972896629 Lorrelei Ann Paires Student in an Organized Health Care Education/Training Program 611 Northern Blvd, Suite 100, Great Neck, NY 11021-5207 2011-05-26
1083906192 Erica Colligan Student in an Organized Health Care Education/Training Program 611 Northern Blvd, Suite 150, Great Neck, NY 11021-5207 2011-05-07
1710144191 Andrew David Goodwillie Orthopaedic Surgery 611 Northern Blvd, Suite 200, Great Neck, NY 11021-5207 2008-05-22
1134312440 Ariel Tenny Goldman Orthopaedic Surgery 611 Northern Blvd, Suite 200, Great Neck, NY 11021-5207 2007-08-20
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Providers in the same zip code

NPI Name Taxonomy Address Enumeration
1366929267 Vishva Vajra Acupuncture PC Acupuncturist 23a Middle Neck Road, Great Neck, NY 11021 2018-07-24
1518457530 Assured Quality Home Care, Inc. In Home Supportive Care 885 Northern Blvd., Greak Neck, NY 11021 2018-05-15
1881183275 Liat Mindy Brody Occupational Therapist 7 Hickory Dr, Great Neck, NY 11021 2018-05-01
1457853707 Allison Squillace Social Worker 7 Bond Suite 1a, Great Neck, NY 11021 2018-03-02
1275042855 Seolhee Kang Acupuncturist 26 Linden Street, Apt 4c, Great Neck, NY 11021 2017-09-26
1346781598 Sara Dreiblatt Speech-Language Pathologist 211-45 46th Road, Queens, NY 11021 2017-03-20
1962853416 Darron Yelling Do, PC Surgery 305 Northen Blvd, 105, Great Neck, NY 11021 2016-06-27
1114396355 Hongjie Jiang Acupuncturist 79 Cutter Mill Rd, Great Neck, NY 11021 2015-09-17
1225425838 Barbara Covell Social Worker 5 Bond St., Great Neck, NY 11021 2015-04-21
1447642343 Kathryn Daly Behavior Analyst 1 Barstow Road Suite #306, Kids First Spectrum Services Inc, Great Neck, NY 11021 2015-03-02
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Taxonomy Information

Taxonomy Code 363A00000X
Grouping Physician Assistants & Advanced Practice Nursing Providers
Classification Physician Assistant

Taxonomy Definition

A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician.

Providers in the same taxonomy and city

NPI Name Taxonomy Address Enumeration
1376995993 Beth Jennifer Monteverde Physician Assistant 600 Northern Blvd Ste 111, Great Neck, NY 11021-5200 2016-07-07
1639530462 Janet Hebroni Physician Assistant 15 North Rd, Great Neck, NY 11024-1933 2016-03-07
1063815942 Peri Santodonato Physician Assistant 5 Imperial Ct, Great Neck, NY 11023-2240 2014-10-06
1952653248 Keri Bianco Physician Assistant Northwell Health Orthopaedic Institute, 611 Northern Boulevard, Suite 200, Great Neck, NY 11021-5208 2012-10-10
1518254325 Kevin Patrick Rooney Physician Assistant 900 Northern Blvd Ste 230, Great Neck, NY 11021-5302 2011-06-30
1336431576 Ronit Shabtian Physician Assistant 5 Robin Way, Great Neck, NY 11021 2011-05-05
1336431535 Yasaman Chadi Physician Assistant 90 Knightsbridge Rd, Great Neck, NY 11021-4546 2011-05-05
1568780179 Dara Bruckner Physician Assistant 17 Brokaw Lane, Great Neck, NY 11023 2010-05-06
1053576660 Ghazaleh Yasmeh Physician Assistant 60 Knights Bridge Rd, Apt# 1d, Great Neck, NY 11021 2008-07-23
1922167121 Filomena Abitino Physician Assistant 11 Grace Avenue Ste 100, Bodian Dermatology Group, Great Neck, NY 11021 2006-12-06
Find all providers in GREAT NECK

Competitor

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City GREAT NECK
Zip Code 11021

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Dataset Information

Data Provider Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES)
Jurisdiction Medicare & Medicaid

This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.

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