Healthcare Provider Details

I. General information

NPI: 1871412353
Provider Name (Legal Business Name): JALEELA A JACKSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/10/2026
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 NEWARK AVE STE 303A
JERSEY CITY NJ
07306-1326
US

IV. Provider business mailing address

550 NEWARK AVE STE 303A
JERSEY CITY NJ
07306-1326
US

V. Phone/Fax

Practice location:
  • Phone: 201-880-7787
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number46TR01301200
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: