Jackson Dermatology PLLC

Primary specialty

SpecialistTaxonomy code 174400000X

License

177618 Issued in NY

Legal business name

JACKSON DERMATOLOGY PLLC

Practice address

55 Greene Ave
Suite 2D
Brooklyn, NY 11238-1026

Phone

(914) 449-4970

NPI assigned

Jul 28, 2009

Organization subpart

No

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

Authorized official

Name

Mr. Michael E Jackson, M.D.NPI 1912991019

Title

Owner

Phone

(914) 449-6970

Specialties & licenses 1

Addresses

Locations

Practitioners 1

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

• Michael E. Jackson, M.D.

  • Dermatology Physician
  • Brooklyn, NY
  • NPI 1912991019
  NPD Authorized official

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

{
    "created_epoch": "1248739200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1248739200000",
    "number": "1275764011",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "55 GREENE AVE",
            "address_2": "SUITE 2D",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112381026",
            "telephone_number": "914-449-4970"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "55 GREENE AVE",
            "address_2": "SUITE 2D",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112381026",
            "telephone_number": "914-449-4970"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JACKSON DERMATOLOGY PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-07-28",
        "last_updated": "2009-07-28",
        "status": "A",
        "authorized_official_last_name": "JACKSON",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "914-449-6970",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "NY",
            "license": "177618",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Shante Z Jack, LMSW
• Jackie Voluz LCSW PLLC
• Jalilah Jackman
• Tanesha T Jackman
• Gracenell Phileen Jackson David
• Daria C Jackson-Legagneur
• Tanya Olaiya Jackson-Soufiane, DPM
• Alicia Jackson, LMSW
• Alicia Carol Jackson, 01/31/05
• Allan James Jackson I

• Specialist in Brooklyn, NY
• Providers in Brooklyn, NY by specialty
• Specialist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 28, 2009; 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.