Individual
ANNA ELIZABETH JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
305 E 161ST ST, BRONX, NY 10451-3535
(917) 219-5720
Mailing address
305 E 161ST ST, BRONX, NY 10451-3535
(917) 219-5720
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
261306
NY
Other
Enumeration date
05/04/2011
Last updated
05/04/2011
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