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General NPI Number Information
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NPI Number | 1548677974
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Entity Type | Individual
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Provider Name | JOSHUA ROBERT ACKERMAN MD
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Gender | Male
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Dates
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Enumeration Date | 07/17/2014
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Last Update Date | 02/18/2019
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Provider Practice Location Address
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Address Line | 1406 6TH AVENUE NORTH ST CLOUD HOSPITAL
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City | ST CLOUD
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State | MN
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Zip | 56303-1901
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Country | US
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Telephone | 320-251-2700
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Fax | 320-656-7115
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Provider Business Mailing Address
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Address Line | 3131 PRINCETON PIKE BUILDING 5 SUITE 109
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City | LAWRENCEVILLE
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State | NJ
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Zip | 08648
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Country | US
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Telephone | 609-989-9211
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Fax | 609-896-0249
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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 | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 25MA09738800
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 279149
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number | 279149
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License Number State | NY
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Taxonomy #4
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 60636
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License Number State | MN
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