Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | 25MA07763900 | NJ |
N | 207XX0005X | Sports Medicine Orthopaedic Surgeon | A94653 | CA |
NPI | 1114989829 |
---|---|
Provider Name | Jason P Garcia |
First Address | West Orange, NJ 07052-1174 |
Second Address | West Orange, NJ 07052-1174 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/04/2006 |
Last Update Date | 03/08/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
25MA07763900 | NJ LICENSE (01) | NJ |
7343801 | CAQH (01) | CA |
A94653 | CA LICENSE (01) | CA |