Healthcare Provider Details

I. General information

NPI: 1285149856
Provider Name (Legal Business Name): MIGUEL SIERRA GARCIA RN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/05/2017
Last Update Date: 01/06/2026
Certification Date: 01/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

99 GORGE RD APT 1511
EDGEWATER NJ
07020-1097
US

IV. Provider business mailing address

99 GORGE RD APT 1511
EDGEWATER NJ
07020-1097
US

V. Phone/Fax

Practice location:
  • Phone: 718-514-4651
  • Fax:
Mailing address:
  • Phone: 718-514-4651
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number26NJ15501900
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number26NR22651800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: