Provider Demographics
NPI:1972861318
Name:MARTIN, LAURA YOUNG (MD)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:YOUNG
Last Name:MARTIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3600 ROUTE 66 FL 3
Mailing Address - Street 2:
Mailing Address - City:NEPTUNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07753-2645
Mailing Address - Country:US
Mailing Address - Phone:732-807-0877
Mailing Address - Fax:201-751-1680
Practice Address - Street 1:30 PROSPECT AVE STE 3
Practice Address - Street 2:
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07601-1915
Practice Address - Country:US
Practice Address - Phone:551-996-2237
Practice Address - Fax:551-996-0734
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-23
Last Update Date:2022-04-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MD1111111208600000X
NJ25MA112026002086S0120X
NY3111682086S0120X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0120XAllopathic & Osteopathic PhysiciansSurgeryPediatric SurgeryGroup - Multi-Specialty
No208600000XAllopathic & Osteopathic PhysiciansSurgery