Provider Demographics
NPI:1598394363
Name:GARCIA, NICCOLO OALICAN
Entity Type:Individual
Prefix:MR
First Name:NICCOLO
Middle Name:OALICAN
Last Name:GARCIA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8604 GRAND AVE APT 2E
Mailing Address - Street 2:
Mailing Address - City:ELMHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11373-4316
Mailing Address - Country:US
Mailing Address - Phone:646-750-7602
Mailing Address - Fax:
Practice Address - Street 1:8604 GRAND AVE APT 2E
Practice Address - Street 2:
Practice Address - City:ELMHURST
Practice Address - State:NY
Practice Address - Zip Code:11373-4316
Practice Address - Country:US
Practice Address - Phone:646-750-7602
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-03
Last Update Date:2020-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY040768225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist