Keith Ryan Jackson Md Pc

LBN: Keith Ryan Jackson Md Pc
Keith Ryan Jackson Md Pc is an health care organization with primary practice located at 11 Ralph Pl Suite 209, Staten Island NY 10304-4419. The organization recently has only one registered license in Allopathic & Osteopathic Physicians / Dermatology, which is considered as the primary health care specialty. Keith Ryan Jackson Md Pc can be contacted via phone (718) 727-1331, or through Jackson, Keith Ryan via phone (718) 727-1331.

Contact Information

Primary practice address
11 Ralph Pl Suite 209 Staten Island NY 10304-4419
Phone: (718) 727-1331
Fax: (718) 727-2159
Website:
Map and Directions
Authorized official contact:
Name: Jackson, Keith Ryan Doctor of Medicine (MD)
Phone: (718) 727-1331

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Dermatology 207N00000X 212165 New York

Profile Details

NPI number 1326216847
LBN Legal business name Keith Ryan Jackson Md Pc
DBA Doing business as
Authorized official Jackson, Keith Ryan Doctor of Medicine (MD)
Entity Organization
Organization subpart 1 No
Enumeration date Feb 19th, 2008
Last updated May 29th, 2013 - about 13 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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Identifiers

StateTypeNumberIssuer
All States NPI 1326216847 NPPES
New York MEDICAID 02239307

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