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General NPI Number Information
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NPI Number | 1326863473
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Entity Type | Individual
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Provider Name | JESSE K ERCKERT
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Gender | Male
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Dates
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Enumeration Date | 11/22/2024
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Last Update Date | 06/14/2025
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Provider Practice Location Address
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Address Line | 515 MADISON AVE
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City | NEW YORK
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State | NY
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Zip | 10022-5403
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Country | US
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Telephone | 646-394-9996
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Fax |
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Provider Business Mailing Address
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Address Line | 16 ERIN LN # A
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City | OLD BRIDGE
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State | NJ
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Zip | 08857-2755
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Country | US
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Telephone | 732-688-8635
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | F406920-01
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 163WP0809X
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Taxonomy Name | Adult Psychiatric/Mental Health Registered Nurse
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License Number | 26NR20291200
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License Number State | NJ
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