=====================================================
General NPI Number Information
=====================================================
NPI Number | 1467500157
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MARIA DEL SOCORRO ACOSTA DDS
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/08/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 295 FORT WASHINGTON AVE SUITE C
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10032-1210
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 212-781-4673
-----------------------------------------------------
Fax | 212-781-4675
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 95 VAN ORDEN AVE PH
-----------------------------------------------------
City | LEONIA
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07605-1520
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 212-781-4673
-----------------------------------------------------
Fax | 212-781-4675
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | 048018
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------