MEDICARE: YEXENIA ACOSTA

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	174400000X	Specialist	738930	NY

General Provider Information

NPI Number	:	1346682630
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YEXENIA ACOSTA

Provider Business Mailing Address
First Line	:	1786 BROOKLYN AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11210-4240
Country	:	US
Telephone Number	:	347-206-2054
Fax Number	:

Provider Business Practice Location Address
First Line	:	1786 BROOKLYN AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11210-4240
Country	:	US
Telephone Number	:	347-206-2054
Fax Number	:

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

Provider Enumeration Date	:	07/27/2013
Last Update Date	:	07/27/2013

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Directions to “ YEXENIA ACOSTA ” Practice Location

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