Provider Demographics
NPI:1518726348
Name:ACOSTA, NINA MERCEDES (DPT)
Entity Type:Individual
Prefix:
First Name:NINA
Middle Name:MERCEDES
Last Name:ACOSTA
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:346 LEON AVE
Mailing Address - Street 2:
Mailing Address - City:PERTH AMBOY
Mailing Address - State:NJ
Mailing Address - Zip Code:08861-2124
Mailing Address - Country:US
Mailing Address - Phone:732-570-9204
Mailing Address - Fax:
Practice Address - Street 1:246 RYDERS LN
Practice Address - Street 2:
Practice Address - City:MILLTOWN
Practice Address - State:NJ
Practice Address - Zip Code:08850-1353
Practice Address - Country:US
Practice Address - Phone:732-246-3585
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-14
Last Update Date:2024-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA02237400225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist