Provider Demographics
NPI:1285240267
Name:ACOSTA, CRISTEL VIVIANA (LICENSED MASSAGE THE)
Entity type:Individual
Prefix:
First Name:CRISTEL
Middle Name:VIVIANA
Last Name:ACOSTA
Suffix:
Gender:F
Credentials:LICENSED MASSAGE THE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:87-87 144 ST APT 3A
Mailing Address - Street 2:
Mailing Address - City:JAMAICA, QUEENS
Mailing Address - State:NY
Mailing Address - Zip Code:11435
Mailing Address - Country:US
Mailing Address - Phone:347-520-2116
Mailing Address - Fax:
Practice Address - Street 1:55 MAPLE AVE
Practice Address - Street 2:
Practice Address - City:ROCKVILLE CENTRE
Practice Address - State:NY
Practice Address - Zip Code:11570
Practice Address - Country:US
Practice Address - Phone:516-705-8836
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-16
Last Update Date:2020-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY030698-01225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist