Individual
SHANE TATAR
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
389 MERRICK AVE, MERRICK, NY 11566-2723
(516) 867-5132
(516) 867-5519
Mailing address
221 BROADWAY, 207, AMITYVILLE, NY 11701-2780
(631) 598-0009
(631) 598-0099
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
019324
NY
Other
Enumeration date
06/04/2016
Last updated
05/23/2023
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