MEDICARE: JACKSON ROBINSON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106S00000X	Behavior Technician	RBT-21-185070	IN

General Provider Information

NPI Number	:	1275289118
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACKSON ROBINSON

Provider Business Mailing Address
First Line	:	1187 LAKEWOOD FARMINGDALE RD
Second Line	:
City	:	HOWELL
State	:	NJ
Zip	:	07731-8689
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5868 E 71ST ST STE E-533
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46220-4075
Country	:	US
Telephone Number	:	844-525-5226
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/01/2022
Last Update Date	:	03/01/2022

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Directions to “ JACKSON ROBINSON ” Practice Location

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