Individual
KIM B JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
29 GLEN COVE AVE STE 212, GLEN COVE, NY 11542-2831
(516) 384-7670
Mailing address
1360 C ST, ELMONT, NY 11003-3816
(516) 384-7670
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
028858
NY
Other
Enumeration date
10/18/2020
Last updated
10/18/2020
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