Provider Demographics
NPI:1497872337
Name:ACOSTA, VICTOR M (RD)
Entity Type:Individual
Prefix:
First Name:VICTOR
Middle Name:M
Last Name:ACOSTA
Suffix:
Gender:M
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1262 BOSTON ROAD
Mailing Address - Street 2:BOSTON ROAD MEDICAL CENTER
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10456
Mailing Address - Country:US
Mailing Address - Phone:212-781-5889
Mailing Address - Fax:212-781-5805
Practice Address - Street 1:1262 BOSTON ROAD
Practice Address - Street 2:BOSTON ROAD MEDICAL CENTER
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10456
Practice Address - Country:US
Practice Address - Phone:212-781-5889
Practice Address - Fax:212-781-5805
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-24
Last Update Date:2011-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2273133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP51497Medicare UPIN
NY03P731Medicare ID - Type UnspecifiedMEDICARE ID