Provider Demographics
NPI:1053306357
Name:GARCIA, JOSEPH L (MD)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:L
Last Name:GARCIA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:502 HAMBURG TPKE
Mailing Address - Street 2:SUITE 105
Mailing Address - City:WAYNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07470-8431
Mailing Address - Country:US
Mailing Address - Phone:973-790-7655
Mailing Address - Fax:973-942-8818
Practice Address - Street 1:502 HAMBURG TPKE
Practice Address - Street 2:SUITE 105
Practice Address - City:WAYNE
Practice Address - State:NJ
Practice Address - Zip Code:07470-8431
Practice Address - Country:US
Practice Address - Phone:973-790-7655
Practice Address - Fax:973-942-8818
Is Sole Proprietor?:No
Enumeration Date:2005-09-13
Last Update Date:2014-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA40452208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
A61075Medicare UPIN
453708Medicare ID - Type Unspecified