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NPI Code Detail

MEDICARE: MARTHA MCKENNA PA

MEDICARE: MARTHA MCKENNA PA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1208800000XUrology Physician034909NY
2363A00000XPhysician Assistant034909NY

General Provider Information

NPI Number : 1013887132
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARTHA MCKENNA PA
Provider Business Mailing Address
First Line : 150 55TH ST
Second Line :
City : BROOKLYN
State : NY
Zip : 11220-2508
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 150 55TH ST
Second Line :
City : BROOKLYN
State : NY
Zip : 11220-2508
Country : US
Telephone Number : 718-630-7000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/05/2025
Last Update Date : 05/15/2026

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Directions to “ MARTHA MCKENNA PA” Practice Location

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