Jackson, Crystal L

Jackson, Crystal L is an individual health care provider with primary practice located at 61 1St St , South Orange NJ 07079-1900. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant, which is considered as her primary health care specialty. Jackson, Crystal L can be contacted via phone (973) 762-8344.

Contact Information

Primary practice address
61 1St St South Orange NJ 07079-1900
Phone: (973) 762-8344
Fax: (973) 762-1626
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant 363A00000X 25MP00046700 New Jersey

Profile Details

NPI number 1548298953
LBN Legal business name Jackson, Crystal L
Credentials PA C
Entity Individual
Sole proprietor 1 No
Enumeration date Jun 28th, 2006
Last updated Jun 24th, 2010 - about 16 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1548298953 NPPES
New Jersey Other P3404235 OXFORD

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