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Organization
JACKSON DERMATOLOGY PLLC
Active
Organization
JACKSON DERMATOLOGY PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MICHAEL E JACKSON M.D. (OWNER)
(914) 449-6970
Entity
Organization
Contact information
Practice address
55 GREENE AVE, SUITE 2D, BROOKLYN, NY 11238-1026
(914) 449-4970
Mailing address
55 GREENE AVE, SUITE 2D, BROOKLYN, NY 11238-1026
(914) 449-4970
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
177618
NY
Other
Enumeration date
07/28/2009
Last updated
07/28/2009
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