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Individual

MARGARET ALENE JACKSON

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
M.D.

Contact information

Practice address
2698 FREDERICK DOUGLASS BLVD, NEW YORK, NY 10030-1219
(212) 939-8966
(212) 939-8973
Mailing address
3 MICHELLE ST, MONROE TOWNSHIP, NJ 08831-8620
(732) 723-1560

Taxonomy

Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
156733-1
NY

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
01115333
NY
Enumeration date
01/15/2007
Last updated
07/08/2007
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