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General NPI Number Information
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NPI Number | 1265411474
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Entity Type | Organization
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Legal Business Name | HARRY JACKSON MD PC
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Dates
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Enumeration Date | 01/16/2006
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Last Update Date | 01/07/2008
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Provider Practice Location Address
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Address Line | 140 ALCOTT PL
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City | BRONX
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State | NY
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Zip | 10475-4302
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Country | US
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Telephone | 718-379-4444
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Fax |
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Provider Business Mailing Address
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Address Line | 2600 NETHERLAND AVE
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City | BRONX
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State | NY
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Zip | 10463-4801
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Country | US
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Telephone | 718-379-4444
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Fax |
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Authorized Official
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Title or Position | SOLE PROPRIETER
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Name | HARRY JACKSON
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Credential |
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Telephone | 718-379-4444
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 173000000X
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Taxonomy Name | Legal Medicine
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License Number | 511301
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License Number State | NY
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