Healthcare Provider Details

I. General information

NPI: 1992853634
Provider Name (Legal Business Name): SANDRA PATRICIA GARCIA DPM PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/08/2007
Last Update Date: 03/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4331 KISSENA BLVD STREET LEVEL
FLUSHING NY
11355-2921
US

IV. Provider business mailing address

7802 65TH ST
GLENDALE NY
11385-6804
US

V. Phone/Fax

Practice location:
  • Phone: 917-434-8302
  • Fax: 718-709-7652
Mailing address:
  • Phone: 917-434-8302
  • Fax: 718-709-7652

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberN005534
License Number StateNY

VIII. Authorized Official

Name: DR. SANDRA PATRICIA GARCIA
Title or Position: OWNER
Credential: DPM
Phone: 917-434-8302