Individual
DAVID BRUCE JACK JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
281 1ST AVE, NEW YORK, NY 10003-2925
(212) 420-2000
Mailing address
214 PINE RD, CORAM, NY 11727-2410
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
025760
NY
Other
Enumeration date
12/02/2020
Last updated
12/02/2020
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