Shane Tatar, PA

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

019324 Issued in NY

Practice address

389 Merrick Ave
Merrick, NY 11566-2723

Phone

(516) 867-5132

Fax

(516) 867-5519

NPI assigned

Jun 4, 2016

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

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

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

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

• Doctors Medical Office PLLC

  • Primary Care Clinic/Center
  • Merrick, NY
  • NPI 1164848818
  Medicare reassignment
• Family Medical Practice of Long Island P.C.

  • Family Medicine Physician
  • Amityville, NY
  • NPI 1972678183
  NPD (past)
• PJS Medical Diagnostic PLLC

  • Diagnostic Radiology Physician
  • Port Jefferson Station, NY
  • NPI 1609110295
  NPD (past)

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

{
    "created_epoch": "1464998400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1684800000000",
    "number": "1770932303",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "221 BROADWAY",
            "address_2": "207",
            "city": "AMITYVILLE",
            "state": "NY",
            "postal_code": "117012780",
            "telephone_number": "631-598-0009",
            "fax_number": "631-598-0099"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "389 MERRICK AVE",
            "city": "MERRICK",
            "state": "NY",
            "postal_code": "115662723",
            "telephone_number": "516-867-5132",
            "fax_number": "516-867-5519"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TATAR",
        "first_name": "SHANE",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-06-04",
        "last_updated": "2023-05-23",
        "certification_date": "2023-05-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "NY",
            "license": "019324",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lisa Beth Tabman
• Emily Anne Tabor, M.A. CCC-SLP
• Neil Andrew Tafeen, PH.D.
• Brianna Tambone
• Olivia Gail Tardif, DDS
• Linda Emma Tavella
• Derek Taylor
• Hannah Teigman, PA-C
• Oliver Tello, MS, PT
• Pamela Adriana Tello, DPT

• Medical Physician Assistant in Merrick, NY
• Providers in Merrick, NY by specialty
• Medical Physician Assistant in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 23, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.