Individual
MR. JOHN H JACKSON JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
66 HAWKINS ST, NEWARK, NJ 07105-4318
(862) 272-9354
Mailing address
66 HAWKINS ST, NEWARK, NJ 07105-4318
(862) 272-9354
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
J0062-40768-06852
NJ
Other
Enumeration date
03/09/2023
Last updated
03/09/2023
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