MEDICARE: MS. YESSENIA ACOSTA PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	018607	NY

General Provider Information

NPI Number	:	1033590260
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. YESSENIA ACOSTA PA-C

Provider Business Mailing Address
First Line	:	3744 90TH ST
Second Line	:
City	:	JACKSON HEIGHTS
State	:	NY
Zip	:	11372-7830
Country	:	US
Telephone Number	:	718-255-1542
Fax Number	:

Provider Business Practice Location Address
First Line	:	3744 90TH ST
Second Line	:
City	:	JACKSON HEIGHTS
State	:	NY
Zip	:	11372-7830
Country	:	US
Telephone Number	:	718-255-1542
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/12/2015
Last Update Date	:	06/12/2015

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