Provider Demographics
NPI:1548677974
Name:ACKERMAN, JOSHUA ROBERT (MD)
Entity type:Individual
Prefix:DR
First Name:JOSHUA
Middle Name:ROBERT
Last Name:ACKERMAN
Suffix:
Gender:M
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:3131 PRINCETON PIKE
Mailing Address - Street 2:BUILDING 5 SUITE 109
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08648
Mailing Address - Country:US
Mailing Address - Phone:609-989-9211
Mailing Address - Fax:609-896-0249
Practice Address - Street 1:1406 6TH AVENUE NORTH
Practice Address - Street 2:ST CLOUD HOSPITAL
Practice Address - City:ST CLOUD
Practice Address - State:MN
Practice Address - Zip Code:56303-1901
Practice Address - Country:US
Practice Address - Phone:320-251-2700
Practice Address - Fax:320-656-7115
Is Sole Proprietor?:No
Enumeration Date:2014-07-17
Last Update Date:2019-02-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA097388002084P0800X
NY2791492084P0800X, 390200000X
MN606362084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program