Provider Demographics
NPI:1669410676
Name:M J ACKERMAN & ASSOCIATES PC
Entity type:Organization
Organization Name:M J ACKERMAN & ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MELVILLE
Authorized Official - Middle Name:J
Authorized Official - Last Name:ACKERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:856-428-6024
Mailing Address - Street 1:2301 E EVESHAM RD
Mailing Address - Street 2:SUITE 401
Mailing Address - City:VOORHEES
Mailing Address - State:NJ
Mailing Address - Zip Code:08043-4501
Mailing Address - Country:US
Mailing Address - Phone:856-428-6024
Mailing Address - Fax:
Practice Address - Street 1:2301 E EVESHAM RD
Practice Address - Street 2:SUITE 401
Practice Address - City:VOORHEES
Practice Address - State:NJ
Practice Address - Zip Code:08043-4501
Practice Address - Country:US
Practice Address - Phone:856-428-6024
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-02
Last Update Date:2014-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0235938000OtherKEYSONE
NJ454626OtherAMERIHEALTH PPO
NJ0235938000OtherAMERIHEALTH HMO
NJ112225OtherAETNA HMO
NJ5890152OtherAETNAPPO
NJ1073926OtherNJ HEALTH MERCY
NJ112225OtherAETNA HMO