Provider Demographics
NPI:1801178207
Name:RAMON ACOSTA MD PC
Entity type:Organization
Organization Name:RAMON ACOSTA MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RAMON
Authorized Official - Middle Name:
Authorized Official - Last Name:ACOSTA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:856-756-0010
Mailing Address - Street 1:2 LEONARD AVE
Mailing Address - Street 2:
Mailing Address - City:CAMDEN
Mailing Address - State:NJ
Mailing Address - Zip Code:08105-2404
Mailing Address - Country:US
Mailing Address - Phone:856-756-0010
Mailing Address - Fax:856-756-0011
Practice Address - Street 1:2 LEONARD AVE
Practice Address - Street 2:
Practice Address - City:CAMDEN
Practice Address - State:NJ
Practice Address - Zip Code:08105-2404
Practice Address - Country:US
Practice Address - Phone:856-756-0010
Practice Address - Fax:856-756-0011
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-13
Last Update Date:2011-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA05116600261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ4009908Medicaid
PAD19306Medicare UPIN
PA0050521135Medicare NSC