Marilyn M. Jackson, M.D., M.P.H., PLLC

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

189136 Issued in NY

Legal business name

MARILYN M. JACKSON, M.D., M.P.H., PLLC

Practice address

421 W 57TH St
Suite B
New York, NY 10019-1763

Phone

(212) 247-8023

Fax

(212) 247-8024

NPI assigned

Jan 16, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Marilyn M. Jackson, M.D.NPI 1811097744

Title

Ceo

Phone

(917) 549-5268

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in NY

Enrollment records 1

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Marilyn M. Jackson, M.D

  • Internal Medicine Physician
  • New York, NY
  • NPI 1811097744
  Medicare reassignment NPD Authorized official
• Milyoung Rumie Cho, LAC

  • Acupuncturist
  • New York, NY
  • NPI 1942623186
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1168905600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1192406400000",
    "number": "1053462986",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "421 W 57TH ST",
            "address_2": "SUITE B",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100191763",
            "telephone_number": "212-247-8023",
            "fax_number": "212-247-8024"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "421 W 57TH ST",
            "address_2": "SUITE B",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100191763",
            "telephone_number": "212-247-8023",
            "fax_number": "212-247-8024"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARILYN M. JACKSON, M.D., M.P.H., PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-16",
        "last_updated": "2007-10-15",
        "status": "A",
        "authorized_official_last_name": "JACKSON",
        "authorized_official_first_name": "MARILYN",
        "authorized_official_middle_name": "M.",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "917-549-5268",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": "NY",
            "license": "189136",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01447254",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Mariel Chloe Practice LLC
• Mariela Glandt MD, P.C.
• Francesco Giovanni Mariglia, MSAC., LAC.
• Marika Molnar Physical Therapist PC
• Sanjana S Marikunte, MD
• Marilyn Ramirez Mental Health Counseling PLLC
• Marilyn Marin Benavides
• Marin Pharmacy LLC
• Marin Pharmacy LLC
• Nancy Marin-Rojas

• Internal Medicine Physician in New York, NY
• Providers in New York, NY by specialty
• Internal Medicine Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 15, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.