Organization
SURGICAL SPECIALIST OF LONG ISLAND, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. TARA DAWN MARTINEZ DO (PHYSICIAN)
(631) 486-5030
Entity
Organization
Contact information
Practice address
2171 JERICHO TPKE STE 100, COMMACK, NY 11725-2900
(631) 486-5030
(631) 724-4229
Mailing address
2171 JERICHO TPKE STE 100, COMMACK, NY 11725-2900
(631) 486-5030
(631) 724-4229
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
03582670
—
NY
Enumeration date
09/30/2014
Last updated
04/21/2022
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