Provider Demographics
NPI:1740518059
Name:WOODSTOCK, KAREN
Entity type:Individual
Prefix:MS
First Name:KAREN
Middle Name:
Last Name:WOODSTOCK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17608 134TH AVE
Mailing Address - Street 2:
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11434-5810
Mailing Address - Country:US
Mailing Address - Phone:718-249-9869
Mailing Address - Fax:718-341-2734
Practice Address - Street 1:17608 134TH AVE
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11434-5810
Practice Address - Country:US
Practice Address - Phone:917-853-5964
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-24
Last Update Date:2025-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY784647163W00000X, 163WP0808X
NY242671164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered NurseGroup - Multi-Specialty
No164W00000XNursing Service ProvidersLicensed Practical Nurse