NPIMap

Organization Active NPI

Surgical Specialist of Long Island, PC

  • Surgery Physician
  • Commack, NY
National Provider Identifier
1871996223
Registry record updated Apr 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
Legal business name
SURGICAL SPECIALIST OF LONG ISLAND, PC
Practice address
2171 Jericho Tpke Ste 100
Commack, NY 11725-2900
Phone
(631) 486-5030
Fax
(631) 724-4229
NPI assigned
Sep 30, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 21, 2022

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

Authorized official

Name
Dr. Tara Dawn Martinez, DO
Title
Physician
Phone
(631) 486-5030

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208600000X Primary

Addresses

Primary practice location

2171 Jericho Tpke Ste 100
Commack, NY 11725-2900

Mailing address

2171 Jericho Tpke Ste 100
Commack, NY 11725-2900
Phone (631) 486-5030

Other practice location 1

989 W Jericho Tpke
Smithtown, NY 11787-3241
Phone (631) 486-5030

Other identifiers 1

IdentifierTypeStateIssuer
03582670MedicaidNY

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 12

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1412035200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1650499200000",
    "number": "1871996223",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2171 JERICHO TPKE STE 100",
            "city": "COMMACK",
            "state": "NY",
            "postal_code": "117252900",
            "telephone_number": "631-486-5030",
            "fax_number": "631-724-4229"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2171 JERICHO TPKE STE 100",
            "city": "COMMACK",
            "state": "NY",
            "postal_code": "117252900",
            "telephone_number": "631-486-5030",
            "fax_number": "631-724-4229"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "989 W Jericho Tpke",
            "address_purpose": "LOCATION",
            "city": "Smithtown",
            "state": "NY",
            "postal_code": "117873241",
            "country_code": "US",
            "telephone_number": "631-486-5030",
            "fax_number": "631-724-4229",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "SURGICAL SPECIALIST OF LONG ISLAND, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-09-30",
        "last_updated": "2022-04-21",
        "certification_date": "2021-10-28",
        "status": "A",
        "authorized_official_last_name": "MARTINEZ",
        "authorized_official_first_name": "TARA",
        "authorized_official_middle_name": "DAWN",
        "authorized_official_title_or_position": "PHYSICIAN",
        "authorized_official_telephone_number": "631-486-5030",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "03582670",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Commack, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.