Individual
MIGNON JACKMAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
42 DE GRASSE ST, FORDS, NJ 08863-1342
(732) 754-1576
Mailing address
42 DE GRASSE ST, FORDS, NJ 08863-1342
(732) 754-1576
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
690676
NY
Other
Enumeration date
11/13/2015
Last updated
11/13/2015
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