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NPI Code Detail

MEDICARE: REGIS F ACOSTA MD LLC

MEDICARE: REGIS F ACOSTA MD LLC
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
1261QM0850XAdult Mental Health Clinic/Center25MA0732300NJ

General Provider Information

NPI Number : 1427364488
Entity Type Code : Organization
Provider Name (Legal Business Name) : REGIS F ACOSTA MD LLC
Provider Business Mailing Address
First Line : 104 INDEPENDENCE BLVD
Second Line :
City : SICKLERVILLE
State : NJ
Zip : 08081-1039
Country : US
Telephone Number : 856-885-4529
Fax Number :
Provider Business Practice Location Address
First Line : 104 INDEPENDENCE BLVD
Second Line :
City : SICKLERVILLE
State : NJ
Zip : 08081-1039
Country : US
Telephone Number : 856-885-4529
Fax Number :
Authorized Official
Title or Position : OWNER
Name : REGIS F ACOSTA
Credential : MD
Telephone Number : 856-885-4529
Provider Enumeration Date : 08/27/2010
Last Update Date : 09/23/2010

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