Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LG0600X | Nurse Practitioner - Gerontology | 26NJ0088200 | NJ |
NPI | 1033689526 |
---|---|
Provider Name | Miguel Angel Garcia |
First Address | Suffern, NY 10901-4814 |
Second Address | Allendale, NJ 07401-1300 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/11/2018 |
Last Update Date | 12/12/2018 |