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General NPI Number Information
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NPI Number | 1821057514
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Entity Type | Individual
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Provider Name | ARTHUR CRAWFORD JACKSON M.D.
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Gender | Male
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Dates
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Enumeration Date | 03/21/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 2021 GRAND CONCOURSE SUITE 711
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City | BRONX
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State | NY
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Zip | 10453-4304
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Country | US
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Telephone | 718-960-0393
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Fax |
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Provider Business Mailing Address
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Address Line | 153 BENNETT AVE APT. 2D
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City | NEW YORK
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State | NY
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Zip | 10040-4012
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Country | US
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Telephone | 212-923-1957
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0804X
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Taxonomy Name | Child & Adolescent Psychiatry Physician
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License Number | 181006
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License Number State | NY
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