Individual
DAVID IRA JACKSON
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
101 HOSPITAL ROAD, MEDICAL CENTER, PATCHOGUE, NY 11772
(631) 687-2953
(610) 617-6280
Mailing address
PO BOX 13700-1378, BROOKHAVEN MEMORIAL HOSPITAL ER, PHILADELPHIA, PA 19191-1378
(800) 666-2455
(610) 617-6280
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
005486
NY
Other
Enumeration date
06/14/2006
Last updated
07/08/2007
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