Provider Demographics
NPI:1629167119
Name:ACOSTA, ELOISA PAREDES (MD)
Entity Type:Individual
Prefix:DR
First Name:ELOISA
Middle Name:PAREDES
Last Name:ACOSTA
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 1:11114 76TH AVE
Mailing Address - Street 2:
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-6410
Mailing Address - Country:US
Mailing Address - Phone:718-793-2340
Mailing Address - Fax:718-793-3024
Practice Address - Street 1:11114 76TH AVE
Practice Address - Street 2:
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-6410
Practice Address - Country:US
Practice Address - Phone:718-793-2340
Practice Address - Fax:718-793-3024
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY148021208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics