MEDICARE: DR. MABEL ACEVEDO M.D.

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	207R00000X	Internal Medicine Physician	176049	NY

General Provider Information

NPI Number	:	1457481707
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MABEL ACEVEDO M.D.

Provider Business Mailing Address
First Line	:	1865 RANDALL AVE
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10473-2932
Country	:	US
Telephone Number	:	646-296-6926
Fax Number	:

Provider Business Practice Location Address
First Line	:	1 HAVEN PLZ
Second Line	:	GOUND FLOOR
City	:	NEW YORK
State	:	NY
Zip	:	10009-3904
Country	:	US
Telephone Number	:	212-677-3973
Fax Number	:	212-677-3974

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

Provider Enumeration Date	:	03/06/2007
Last Update Date	:	05/30/2008

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