Healthcare Provider Details

I. General information

NPI: 1144223264
Provider Name (Legal Business Name): FRANCISCO ANTONIO GARCIA-MORENO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2005
Last Update Date: 09/19/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

410 LAKEVILLE RD STE 311
LAKE SUCCESS NY
11042-1103
US

IV. Provider business mailing address

410 LAKEVILLE RD STE 311
LAKE SUCCESS NY
11042-1103
US

V. Phone/Fax

Practice location:
  • Phone: 516-358-2400
  • Fax: 516-358-5454
Mailing address:
  • Phone: 516-358-2400
  • Fax: 516-358-5454

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number183172
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: