Healthcare Provider Details

I. General information

NPI: 1669567210
Provider Name (Legal Business Name): MARIO J GARCIA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 04/07/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 EAST 98TH STREET 3RD FLOOR
NEW YORK NY
10029
US

IV. Provider business mailing address

ONE GUSTAVE L LEVY PLACE
NEW YORK NY
10029
US

V. Phone/Fax

Practice location:
  • Phone: 212-241-5586
  • Fax: 212-876-1493
Mailing address:
  • Phone: 212-241-5586
  • Fax: 212-876-1493

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number242100
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: