Organization
HARRY JACKSON MD PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
HARRY JACKSON (SOLE PROPRIETER)
(718) 379-4444
Entity
Organization
Contact information
Practice address
140 ALCOTT PL, BRONX, NY 10475-4302
(718) 379-4444
Mailing address
2600 NETHERLAND AVE, BRONX, NY 10463-4801
(718) 379-4444
Taxonomy
Speciality
Code
Description
License number
State
173000000X
Legal Medicine
Primary
511301
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00196483
—
NY
Enumeration date
01/16/2006
Last updated
01/07/2008
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