Provider Demographics
NPI:1457481707
Name:ACEVEDO, MABEL (MD)
Entity Type:Individual
Prefix:DR
First Name:MABEL
Middle Name:
Last Name:ACEVEDO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1865 RANDALL AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10473-2932
Mailing Address - Country:US
Mailing Address - Phone:646-296-6926
Mailing Address - Fax:
Practice Address - Street 1:1 HAVEN PLZ
Practice Address - Street 2:GOUND FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10009-3904
Practice Address - Country:US
Practice Address - Phone:212-677-3973
Practice Address - Fax:212-677-3974
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-06
Last Update Date:2008-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY176049207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYD92266Medicare UPIN