Provider Demographics
NPI:1720215015
Name:GARCIA, HAYDEE (NP)
Entity Type:Individual
Prefix:
First Name:HAYDEE
Middle Name:
Last Name:GARCIA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:HAYDEE
Other - Middle Name:
Other - Last Name:GARCIA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NP
Mailing Address - Street 1:79 MADISON AVE
Mailing Address - Street 2:FLOOR 6
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-7802
Mailing Address - Country:US
Mailing Address - Phone:212-545-2439
Mailing Address - Fax:646-935-4648
Practice Address - Street 1:150 ESSEX ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10002-2301
Practice Address - Country:US
Practice Address - Phone:212-477-1120
Practice Address - Fax:212-477-8367
Is Sole Proprietor?:No
Enumeration Date:2009-06-15
Last Update Date:2009-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF430323363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY000695941Medicaid
NYW6L111Medicare PIN
NY000695941Medicaid