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General NPI Number Information
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NPI Number | 1558976696
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Entity Type | Individual
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Provider Name | CARLO ACOSTA BSMT
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Gender | Male
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Dates
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Enumeration Date | 09/15/2020
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Last Update Date | 09/15/2020
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Provider Practice Location Address
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Address Line | 7 W 51ST ST FL 5
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City | NEW YORK
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State | NY
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Zip | 10019-6905
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Country | US
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Telephone | 212-651-7515
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Fax |
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Provider Business Mailing Address
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Address Line | 1 MELBOURNE RD
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City | GREAT NECK
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State | NY
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Zip | 11021-4636
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Country | US
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Telephone | 917-545-2065
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 156F00000X
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Taxonomy Name | Technician/Technologist
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License Number | 010446
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License Number State | NY
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