=====================================================
General NPI Number Information
=====================================================
NPI Number | 1811047012
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JOSE R. ACOSTA, M.D., P.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/11/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 27 SANDY LN SUITE 140
-----------------------------------------------------
City | LEWISTOWN
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 17044-1310
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 717-242-2711
-----------------------------------------------------
Fax | 717-248-0502
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 27 SANDY LN SUITE 140
-----------------------------------------------------
City | LEWISTOWN
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 17044-1310
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 717-242-2711
-----------------------------------------------------
Fax | 717-248-0502
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OFFICE MANAGER
-----------------------------------------------------
Name | JUDY K STAYER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 717-242-2711
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------