Healthcare Provider Details

I. General information

NPI: 1790518744
Provider Name (Legal Business Name): JESSE J SPERRY
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/24/2024
Last Update Date: 10/07/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

435 N PROSPECT ST
HERKIMER NY
13350-1912
US

IV. Provider business mailing address

435 N PROSPECT ST
HERKIMER NY
13350-1912
US

V. Phone/Fax

Practice location:
  • Phone: 315-866-0100
  • Fax:
Mailing address:
  • Phone: 315-866-0100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number133893
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: