Healthcare Provider Details

I. General information

NPI: 1255275640
Provider Name (Legal Business Name): JUAN MANUEL GARCIA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/16/2026
Last Update Date: 04/16/2026
Certification Date: 04/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9114 37TH AVE
JACKSON HEIGHTS NY
11372-7920
US

IV. Provider business mailing address

9114 37TH AVE
JACKSON HEIGHTS NY
11372-7920
US

V. Phone/Fax

Practice location:
  • Phone: 718-722-6001
  • Fax:
Mailing address:
  • Phone: 718-722-6001
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License Number247200000X
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: