Provider Demographics
NPI:1366588220
Name:GARCIA, LUIS (PA)
Entity type:Individual
Prefix:MR
First Name:LUIS
Middle Name:
Last Name:GARCIA
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 SUNSET AVE
Mailing Address - Street 2:
Mailing Address - City:FARMINGDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11735-5356
Mailing Address - Country:US
Mailing Address - Phone:516-586-4817
Mailing Address - Fax:
Practice Address - Street 1:COLUMBIA PRESBYTERIAN - EMERGENCY MEDICINE DEPT.
Practice Address - Street 2:5141 BROADWAY
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10034
Practice Address - Country:US
Practice Address - Phone:212-932-4016
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2021-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007756363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant