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Individual

DR. MARK AARON JACKNIN

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
D.O.

Contact information

Practice address
4405 BROADWAY, NEW YORK, NY 10040-4014
(212) 740-2020
(646) 666-0280
Mailing address
PO BOX 746087, ATLANTA, GA 30374-6087
(312) 733-9730

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
230171
NY

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
02716663
NY
Enumeration date
03/23/2006
Last updated
09/01/2023
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