MEDICARE: KRYSTAL M GARCIA PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	021734-1	NY

General Provider Information

NPI Number	:	1669973236
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRYSTAL M GARCIA PA-C

Provider Business Mailing Address
First Line	:	301 E MAIN ST
Second Line	:
City	:	BAY SHORE
State	:	NY
Zip	:	11706-8458
Country	:	US
Telephone Number	:	631-968-3000
Fax Number	:

Provider Business Practice Location Address
First Line	:	6 VAN NAME AVE
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10303-2514
Country	:	US
Telephone Number	:	516-297-5661
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/28/2018
Last Update Date	:	03/23/2018

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