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Individual

KIMBERLY A JACKUS

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
MD

Contact information

Practice address
3127 41ST ST, ASTORIA, NY 11103-3901
(718) 721-6989
Mailing address
PO BOX 280, MILLTOWN, NJ 08850-0280
(800) 738-1659

Taxonomy

Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
186183-1
NY

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
02111686
NY
Enumeration date
06/23/2005
Last updated
09/05/2013
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