Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Ivy Tan Meneses

Individual provider Cardiovascular Disease Physician · NPI 1629626221

Ivy Tan Meneses is a Nurse Practitioner in Commack, New York. Qualified in 2020, 6 years ago. Practices with North Shore-Lij Medical PC, a 6,350-clinician group and accepts Medicare assignment. Licensed in New York.

Years since qualifying
6
Licensed in
NY
In the registry since
2019
Specialties on file
2
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Practice location Address checks out

27 Cottonwood Dr
Commack, NY 11725-2420
Phone: (631) 875-1851
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Acute Care Nurse Practitioner (primary) Taxonomy 363LA2100X · Licence F431560-01 (NY)
Cardiovascular Disease Physician Taxonomy 207RC0000X · Licence 431560 (NY)

Record details

NPI number1629626221
Entity typeIndividual (Type 1)
GenderFemale
Sole proprietorYes
NPI enumeratedAugust 28, 2019
Last updated in NPPESNovember 3, 2023
Certification dateNovember 3, 2023
Mailing address300 Community Dr, Manhasset, NY 11030-3816

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyNURSE PRACTITIONER
Medical schoolOTHER
Graduated 2020 (6 years in practice)
Group practice North Shore-Lij Medical Pc — 6350 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations5 on file with Medicare

Other providers in Commack