Provider Demographics
NPI:1588028815
Name:ACKER, JESSICA SARAH (MD)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:SARAH
Last Name:ACKER
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 1:1561 ULSTER AVE
Mailing Address - Street 2:
Mailing Address - City:LAKE KATRINE
Mailing Address - State:NY
Mailing Address - Zip Code:12449
Mailing Address - Country:US
Mailing Address - Phone:845-481-7822
Mailing Address - Fax:845-202-6623
Practice Address - Street 1:450 CLARKSON AVE
Practice Address - Street 2:BOX 59
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11203-2012
Practice Address - Country:US
Practice Address - Phone:718-270-2078
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-13
Last Update Date:2023-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYFN99598KMedicaid
NY00542232Medicaid