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Organization

JERREYLL T JACKSON M.D. P.C

Active
Organization subpart
No

Provider details

NPI number
Authorized official
JERREYLL T JACKSON (PROVIDER)
(212) 889-1171
Entity
Organization

Contact information

Practice address
20 E 46TH ST, NEW YORK, NY 10017-2417
(212) 889-1171
Mailing address
20 E 46TH ST, NEW YORK, NY 10017-2417

Taxonomy

Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
237264
NY

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
0168092
NJ
05
02884251
NY
05
2751471
NY
Enumeration date
10/15/2008
Last updated
12/08/2008
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