Provider Demographics
NPI:1447591482
Name:ACOSTA, PABLO JOSE (ATC)
Entity Type:Individual
Prefix:MR
First Name:PABLO
Middle Name:JOSE
Last Name:ACOSTA
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:175 W 87TH ST APT 28C
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10024-2910
Mailing Address - Country:US
Mailing Address - Phone:646-533-5208
Mailing Address - Fax:
Practice Address - Street 1:101 WEST 91 STREET
Practice Address - Street 2:TRINITY SCHOOL
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10024
Practice Address - Country:US
Practice Address - Phone:646-827-6667
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-14
Last Update Date:2013-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY67 002 042146D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146D00000XEmergency Medical Service ProvidersPersonal Emergency Response Attendant