Provider Demographics
NPI:1598707580
Name:ACKERMAN, MELVILLE J (MD)
Entity type:Individual
Prefix:
First Name:MELVILLE
Middle Name:J
Last Name:ACKERMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 BRACKEN RD
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:08055-9164
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:102 BRACKEN RD
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:NJ
Practice Address - Zip Code:08055-9164
Practice Address - Country:US
Practice Address - Phone:856-428-6024
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2025-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA044670207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ223172576OtherHORIZON BLUE CROSS BLUE
NJ223172576OtherDEWVON
NJ10006974OtherRAIL ROAD MEDICARE
NJ1017036OtherNJ HEALTH (MERCY)
NJ223172576OtherUNITED HEALTH CARE
NJ1020397OtherCIGNA
NJ2004208Medicaid
NJ223172576OtherTRICARE CHAMPUS
NJ223172576OtherGREAT WEST
NJP713939OtherOXFORD
NJ509124 GRP#5890OtherAETNA PPO
NJ0069786000OtherKEYSTONE
NJ000001806OtherAMERIHEALTH PPO
NJ0069786000OtherAMERIHEALTH HMO
NJ223172576OtherPHCS
NJ55323 GRP# 112225OtherAETNA HOM
NJF10098OtherHEALTHNET
NJ0069786000OtherAMERIHEALTH HMO
NJP713939OtherOXFORD