Provider Demographics
NPI:1992853634
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:917-434-8302
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:917-434-8302
Mailing Address - Fax:718-709-7652
Practice Address - Street 1:4331 KISSENA BLVD
Practice Address - Street 2:STREET LEVEL
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11355-2921
Practice Address - Country:US
Practice Address - Phone:917-434-8302
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:2007-01-08
Last Update Date:2018-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN005534213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY04652BMedicare PIN