Basic Information
Provider Information
NPI: 1164522488
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: ACUNA
FirstName: REBECCA
MiddleName: P
NamePrefix:  
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 450 WEST 33 RD STREET
Address2: PBS 12TH FLOOR
City: NEW YORK
State: NY
PostalCode: 10001
CountryCode: US
TelephoneNumber: 2123564474
FaxNumber: 2123564608
Practice Location
Address1: 355 BARD AVE
Address2: PEDIATRICS
City: STATEN ISLAND
State: NY
PostalCode: 10310
CountryCode: US
TelephoneNumber: 7188184518
FaxNumber: 7188182739
Other Information
ProviderEnumerationDate: 09/25/2006
LastUpdateDate: 07/08/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
208000000X160610NYY Allopathic & Osteopathic PhysiciansPediatrics 

No ID Information.


Home