Provider Demographics
NPI:1255221412
Name:ACKERMAN, MARIS
Entity type:Individual
Prefix:
First Name:MARIS
Middle Name:
Last Name:ACKERMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 ELM CT
Mailing Address - Street 2:
Mailing Address - City:SANDS POINT
Mailing Address - State:NY
Mailing Address - Zip Code:11050-1911
Mailing Address - Country:US
Mailing Address - Phone:516-220-5378
Mailing Address - Fax:
Practice Address - Street 1:4 ELM CT
Practice Address - Street 2:
Practice Address - City:SANDS POINT
Practice Address - State:NY
Practice Address - Zip Code:11050-1911
Practice Address - Country:US
Practice Address - Phone:516-220-5378
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-08
Last Update Date:2025-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012816133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered