Individual
JOHN PATRICK RENIEDO ACOSTA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
A.T.C.
Contact information
Practice address
1046 MARCH DR, VALLEY STREAM, NY 11580-1841
(551) 587-9223
Mailing address
1046 MARCH DR, VALLEY STREAM, NY 11580-1841
(551) 587-9223
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
002196-1
NY
Other
Enumeration date
11/21/2011
Last updated
11/21/2011
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