Individual
ERNEST JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CPRS
Contact information
Practice address
76 W JIMMIE LEEDS RD STE 402, GALLOWAY, NJ 08205-9400
(609) 573-5260
Mailing address
700 W PARK AVE, PLEASANTVILLE, NJ 08232-4360
(609) 334-4575
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
CPRS-50229
NJ
Other
Enumeration date
04/05/2022
Last updated
04/05/2022
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