Healthcare Provider Details

I. General information

NPI: 1982559290
Provider Name (Legal Business Name): KAREN MARTIN CRPA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KAREN KENNEDY KAREN KENNEDY CRPA

II. Dates (important events)

Enumeration Date: 03/02/2026
Last Update Date: 03/02/2026
Certification Date: 03/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 HEBERTON AVE
STATEN ISLAND NY
10302-1415
US

IV. Provider business mailing address

15 MOSEL AVE APT 2A
STATEN ISLAND NY
10304-4451
US

V. Phone/Fax

Practice location:
  • Phone: 718-448-1900
  • Fax: 718-448-1903
Mailing address:
  • Phone: 718-593-0999
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: