Healthcare Provider Details

I. General information

NPI: 1508809823
Provider Name (Legal Business Name): ROBERT G ACOSTA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/14/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 CLARA MAASS DR
BELLEVILLE NJ
07109-3550
US

IV. Provider business mailing address

5 FRANKLIN AVE SUITE 510
BELLEVILLE NJ
07109-3532
US

V. Phone/Fax

Practice location:
  • Phone: 973-751-2011
  • Fax: 973-751-4456
Mailing address:
  • Phone: 973-751-2011
  • Fax: 973-751-4456

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberMA57761
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: