Provider Demographics
NPI:1891797890
Name:SANDRA PATRICIA GARCIA DPM PC
Entity Type:Organization
Organization Name:SANDRA PATRICIA GARCIA DPM PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:PATRICIA
Authorized Official - Last Name:GARCIA
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:718-542-0472
Mailing Address - Street 1:7802 65TH ST
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11385-6804
Mailing Address - Country:US
Mailing Address - Phone:718-542-0472
Mailing Address - Fax:718-893-0418
Practice Address - Street 1:933 SOUTHERN BLVD
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10459-4507
Practice Address - Country:US
Practice Address - Phone:718-542-0472
Practice Address - Fax:718-709-7652
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SANDRA PATRICIA GARCIA DPM PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-08-10
Last Update Date:2018-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYNOO55342083P0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY041019OtherHEALTH NET
NY03070082Medicaid
PQW842Medicare PIN
NY03070082Medicaid
NY4437530005Medicare NSC