Individual
CAMILLE JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
7000 AUSTIN ST, SUITE200, FOREST HILLS, NY 11375-1022
(718) 762-7633
Mailing address
7000 AUSTIN ST, SUITE200, FOREST HILLS, NY 11375-1022
(718) 762-7633
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
859763
NY
Other
Enumeration date
01/05/2016
Last updated
01/05/2016
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