Healthcare Provider Details

I. General information

NPI: 1093877466
Provider Name (Legal Business Name): MELISSA ACKERMAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/14/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

253 WITHERSPOON ST
PRINCETON NJ
08540-3211
US

IV. Provider business mailing address

917 CANAL RD
PRINCETON NJ
08540-8509
US

V. Phone/Fax

Practice location:
  • Phone: 609-497-4000
  • Fax:
Mailing address:
  • Phone: 908-359-9193
  • Fax: 908-359-6353

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number25MA06358100
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: