Provider Demographics
NPI:1588167456
Name:GARCIA, GIANCARLO (PA)
Entity type:Individual
Prefix:
First Name:GIANCARLO
Middle Name:
Last Name:GARCIA
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
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Mailing Address - Street 1:8 MAPLE AVE
Mailing Address - Street 2:
Mailing Address - City:BAY SHORE
Mailing Address - State:NY
Mailing Address - Zip Code:11706-8722
Mailing Address - Country:US
Mailing Address - Phone:631-665-4392
Mailing Address - Fax:631-665-5008
Practice Address - Street 1:8 MAPLE AVE
Practice Address - Street 2:
Practice Address - City:BAY SHORE
Practice Address - State:NY
Practice Address - Zip Code:11706-8722
Practice Address - Country:US
Practice Address - Phone:631-665-4392
Practice Address - Fax:631-665-5008
Is Sole Proprietor?:No
Enumeration Date:2018-03-16
Last Update Date:2025-08-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY021763363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant