Provider Demographics
NPI:1467500157
Name:ACOSTA, MARIA DEL SOCORRO (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARIA
Middle Name:DEL SOCORRO
Last Name:ACOSTA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:95 VAN ORDEN AVE
Mailing Address - Street 2:PH
Mailing Address - City:LEONIA
Mailing Address - State:NJ
Mailing Address - Zip Code:07605-1520
Mailing Address - Country:US
Mailing Address - Phone:212-781-4673
Mailing Address - Fax:212-781-4675
Practice Address - Street 1:295 FORT WASHINGTON AVE
Practice Address - Street 2:SUITE C
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10032-1210
Practice Address - Country:US
Practice Address - Phone:212-781-4673
Practice Address - Fax:212-781-4675
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY048018122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01932892Medicaid