Provider Demographics
NPI:1730103672
Name:GARCIA, MARCO ANTONIO (MD)
Entity Type:Individual
Prefix:MR
First Name:MARCO
Middle Name:ANTONIO
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 1:30 WILLOW RD
Mailing Address - Street 2:
Mailing Address - City:NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11040-3326
Mailing Address - Country:US
Mailing Address - Phone:516-326-8879
Mailing Address - Fax:
Practice Address - Street 1:40-35 95TH STREET
Practice Address - Street 2:
Practice Address - City:ELMHURST
Practice Address - State:NY
Practice Address - Zip Code:11373
Practice Address - Country:US
Practice Address - Phone:718-803-8463
Practice Address - Fax:718-205-4928
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2014-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY221842207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYH46088Medicare UPIN