Individual
MR. ENRIQUE ALEXANDER ACOSTA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
227 MADISON ST, MEDICAL STAFF OFFICE , R -1249, NEW YORK, NY 10002-7537
(212) 238-7614
(212) 238-7009
Mailing address
227 MADISON ST, MEDICAL STAFF OFFICE , R -1249, NEW YORK, NY 10002-7537
(212) 238-7614
(212) 238-7009
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
016338
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
016338
NYS PHYSICIAN ASSISTANT LICENSE
NY
Enumeration date
10/03/2012
Last updated
01/04/2013
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