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Individual

CRYSTAL L JACKSON

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PA C

Contact information

Practice address
61 1ST ST, SOUTH ORANGE, NJ 07079-1900
(973) 762-8344
(973) 762-1626
Mailing address
61 1ST ST, SOUTH ORANGE, NJ 07079-1900
(913) 762-8344
(973) 762-1626

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
25MP00046700
NJ

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
P3404235
OXFORD
NJ
Enumeration date
06/28/2006
Last updated
06/24/2010
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