Organization
ID OF MASSACHUSETTS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JENNIFER L JACKSON (AUTHORIZED OFFICIAL)
(561) 223-8081
Entity
Organization
Contact information
Practice address
104 QUARRY ST STE 2, QUINCY, MA 02169-4174
(617) 472-6764
(617) 770-9933
Mailing address
4700 EXCHANGE CT STE 110, BOCA RATON, FL 33431-4450
(561) 314-2000
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
—
—
Other
Enumeration date
08/20/2021
Last updated
01/27/2026
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