Individual provider Active NPI

Carol Ann Martin, NP

  • Adult Health Nurse Practitioner
  • East Setauket, NY
National Provider Identifier
1124018239
Registry record updated Jul 13, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Health Nurse PractitionerTaxonomy code 363LA2200X
License
F302776-1 Issued in NY
Practice address
3 Technology Dr
Suite 700
East Setauket, NY 11733-4064
Phone
(631) 444-5220
Fax
(631) 444-5225
NPI assigned
Oct 28, 2005
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 13, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Health Nurse Practitioner 363LA2200X F302776-1 NY Primary

Addresses

Primary practice location

3 Technology Dr
Suite 700
East Setauket, NY 11733-4064

Mailing address

21 Orbit Dr
Stony Brook, NY 11790-3015
Phone (631) 751-3752

Other identifiers 1

IdentifierTypeStateIssuer
02377728MedicaidNY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
F302776-1NYMDAdult Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Stony Brook Internists, University Faculty Practice Corporation Past Accepting new patients

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1130457600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1783900800000",
    "number": "1124018239",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "21 ORBIT DR",
            "city": "STONY BROOK",
            "state": "NY",
            "postal_code": "117903015",
            "telephone_number": "631-751-3752"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3 TECHNOLOGY DR",
            "address_2": "SUITE 700",
            "city": "EAST SETAUKET",
            "state": "NY",
            "postal_code": "117334064",
            "telephone_number": "631-444-5220",
            "fax_number": "631-444-5225"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MARTIN",
        "first_name": "CAROL ANN",
        "name_prefix": "Ms.",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-10-28",
        "last_updated": "2026-07-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "NY",
            "license": "F302776-1",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02377728",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in East Setauket, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2026; 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.