=====================================================
General NPI Number Information
=====================================================
NPI Number | 1770310492
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | AMAURY A GARCIA NP
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/17/2024
-----------------------------------------------------
Last Update Date | 07/29/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 103 RIVER RD
-----------------------------------------------------
City | EDGEWATER
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07020-1016
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 201-308-8995
-----------------------------------------------------
Fax | 201-917-3603
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 316 W 5TH AVE
-----------------------------------------------------
City | ROSELLE
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07203-1142
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 646-506-7597
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LA2200X
-----------------------------------------------------
Taxonomy Name | Adult Health Nurse Practitioner
-----------------------------------------------------
License Number | AG08240062
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------