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Individual
MRS. DENISE SEROTTA JACKSON
Active
Individual
MRS. DENISE SEROTTA JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.T.
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
012831-1
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000499025001
BLUESHIELD OF NE NY
NY
05
—
01699036
—
NY
01
—
DJ0QL58710
EMPIRE BC/BS
NY
Enumeration date
07/07/2005
Last updated
07/13/2026
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