Individual
TALICIA JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
140 BERGEN ST # C, NEWARK, NJ 07103-2425
(973) 972-2700
Mailing address
140 BERGEN ST # C, NEWARK, NJ 07103-2425
(973) 322-5281
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
5MA12190200
NJ
Other
Enumeration date
04/29/2020
Last updated
09/30/2024
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