MEDICARE: MS. MARIA R ACATES TSSLD

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	1283674	NY

General Provider Information

NPI Number	:	1942547401
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MARIA R ACATES TSSLD

Provider Business Mailing Address
First Line	:	3239 82ND ST
Second Line	:
City	:	EAST ELMHURST
State	:	NY
Zip	:	11370-2003
Country	:	US
Telephone Number	:	917-204-7904
Fax Number	:

Provider Business Practice Location Address
First Line	:	3239 82ND ST
Second Line	:
City	:	EAST ELMHURST
State	:	NY
Zip	:	11370-2003
Country	:	US
Telephone Number	:	917-204-7904
Fax Number	:

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

Provider Enumeration Date	:	01/03/2013
Last Update Date	:	03/01/2013

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