Jerreyll T Jackson M.D. P.C

Primary specialty

Ophthalmology PhysicianTaxonomy code 207W00000X

License

237264 Issued in NY

Legal business name

JERREYLL T JACKSON M.D. P.C

Practice address

20 E 46TH St
New York, NY 10017-2417

Phone

(212) 889-1171

NPI assigned

Oct 15, 2008

Organization subpart

No

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

Authorized official

Name

Jerreyll T Jackson

Title

Provider

Phone

(212) 889-1171

Specialties & licenses 1

Addresses

Other identifiers 3

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

{
    "created_epoch": "1224028800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1228694400000",
    "number": "1235381732",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "20 E 46TH ST",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100172417"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20 E 46TH ST",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100172417",
            "telephone_number": "212-889-1171"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JERREYLL T JACKSON M.D. P.C",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-10-15",
        "last_updated": "2008-12-08",
        "status": "A",
        "authorized_official_last_name": "JACKSON",
        "authorized_official_first_name": "JERREYLL",
        "authorized_official_middle_name": "T",
        "authorized_official_title_or_position": "PROVIDER",
        "authorized_official_telephone_number": "212-889-1171"
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Ophthalmology",
            "state": "NY",
            "license": "237264",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0168092",
            "state": "NJ"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2751471",
            "state": "NY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02884251",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Marie-Claire Jerome
• Roy Curtis Jerome, PH.D.
• Stephanie Jerome
• Thamar Jerome
• Ashley Jerominski, MD
• Trisha Jerrick
• Jerry G Blaivas MD
• Jerry L. Halpern DDS Steven J. Tunick DMD
• Jerry Lublin PHD Victoria Beech Lublin PHD Psych Associates PC
• Jerry Weisfogel, M.D. P.C.

• Ophthalmology Physician in New York, NY
• Providers in New York, NY by specialty
• Ophthalmology Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 8, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.