Active NPI
Jonathan Vanderbeck
- Social Worker
- Scotia, NY
National Provider Identifier
1699266346
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Social Worker
- License
- 103136
- Practice address
- 220 N Ballston Ave
Scotia, NY 12302-2533 - Phone
- (518) 374-3514
- NPI assigned
- May 29, 2018
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Social Worker | 104100000X | 103136 | NY | Primary |
Addresses
Primary practice location
220 N Ballston Ave
Scotia, NY 12302-2533
Mailing address
220 N Ballston Ave
Scotia, NY 12302-2533
Phone (518) 374-3514
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Mar 1, 2024 through Mar 1, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 103136 | NY | MD | Social Worker |
| 091119 | NY | MD | Surgery Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1527552000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1537315200000",
"number": "1699266346",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "220 N BALLSTON AVE",
"city": "SCOTIA",
"state": "NY",
"postal_code": "123022533",
"telephone_number": "518-374-3514"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "220 N BALLSTON AVE",
"city": "SCOTIA",
"state": "NY",
"postal_code": "123022533",
"telephone_number": "518-374-3514"
}
],
"practiceLocations": [],
"basic": {
"last_name": "VANDERBECK",
"first_name": "JONATHAN",
"name_prefix": "Mr.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2018-05-29",
"last_updated": "2018-09-19",
"status": "A"
},
"taxonomies": [
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "NY",
"license": "103136",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Scotia, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 19, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.