Healthcare Provider Details

I. General information

NPI: 1669164950
Provider Name (Legal Business Name): BETHANY IRIS ACOSTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2023
Last Update Date: 10/22/2025
Certification Date: 10/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 COMMERCIAL PL
NEWBURGH NY
12550-5306
US

IV. Provider business mailing address

3 COMMERCIAL PL
NEWBURGH NY
12550-5306
US

V. Phone/Fax

Practice location:
  • Phone: 845-220-2146
  • Fax:
Mailing address:
  • Phone: 845-802-3095
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number739167
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: