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NPI Code Detail

MEDICARE: KIMBERLY A JACKUS MD

MEDICARE: KIMBERLY A JACKUS MD
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
1207L00000XAnesthesiology Physician186183-1NY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1558367540
Entity Type Code : Individual
Provider Name (Legal Business Name) : KIMBERLY A JACKUS MD
Provider Business Mailing Address
First Line : PO BOX 280
Second Line :
City : MILLTOWN
State : NJ
Zip : 08850-0280
Country : US
Telephone Number : 800-738-1659
Fax Number :
Provider Business Practice Location Address
First Line : 3127 41ST ST
Second Line :
City : ASTORIA
State : NY
Zip : 11103-3901
Country : US
Telephone Number : 718-721-6989
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/23/2005
Last Update Date : 09/05/2013

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Directions to “ KIMBERLY A JACKUS MD” Practice Location

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