Provider Demographics
NPI:1174931026
Name:GARCIA, ROBERT JEOMARO
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:JEOMARO
Last Name:GARCIA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:123 VAN BUREN ST
Mailing Address - Street 2:
Mailing Address - City:MASTIC
Mailing Address - State:NY
Mailing Address - Zip Code:11950-4101
Mailing Address - Country:US
Mailing Address - Phone:631-839-8699
Mailing Address - Fax:
Practice Address - Street 1:8 AMARR DR
Practice Address - Street 2:
Practice Address - City:SHIRLEY
Practice Address - State:NY
Practice Address - Zip Code:11967-3602
Practice Address - Country:US
Practice Address - Phone:631-839-8699
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-23
Last Update Date:2023-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY318978164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse