Provider Demographics
NPI:1467496935
Name:GARCIA, LEONDA
Entity Type:Individual
Prefix:DR
First Name:LEONDA
Middle Name:
Last Name:GARCIA
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 1:8906 135TH AVE
Mailing Address - Street 2:7L
Mailing Address - City:JAMIACA
Mailing Address - State:NY
Mailing Address - Zip Code:11417-2400
Mailing Address - Country:US
Mailing Address - Phone:718-240-5310
Mailing Address - Fax:
Practice Address - Street 1:1 BROOKDALE PLZ
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11212-3139
Practice Address - Country:US
Practice Address - Phone:718-240-5310
Practice Address - Fax:718-240-6568
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2007-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY109880207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00195340Medicaid
NYB80096Medicare UPIN
NY961131Medicare ID - Type Unspecified