MEDICARE: RICHARD GARCIA SR. ATC

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	2255A2300X	Athletic Trainer	25MT00180600	NJ

General Provider Information

NPI Number	:	1992189203
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RICHARD GARCIA SR. ATC

Provider Business Mailing Address
First Line	:	320 FALLER DR APT A
Second Line	:
City	:	NEW MILFORD
State	:	NJ
Zip	:	07646-5268
Country	:	US
Telephone Number	:	201-838-8535
Fax Number	:

Provider Business Practice Location Address
First Line	:	100 E MAIN ST
Second Line	:
City	:	LITTLE FALLS
State	:	NJ
Zip	:	07424-5628
Country	:	US
Telephone Number	:	973-890-2500
Fax Number	:

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

Provider Enumeration Date	:	07/16/2015
Last Update Date	:	07/16/2015

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