Individual provider Active NPI

Danielle S Jackson, MD MPH

  • Psychiatry Physician
  • New York, NY
National Provider Identifier
1578906905
Registry record updated May 6, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
License
281585 Issued in NY
Practice address
109 W 27TH St RM 5S
New York, NY 10001-6208
Phone
(833) 351-8255
Fax
(888) 815-3583
NPI assigned
Apr 16, 2013
Last updated
May 6, 2025By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 6, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry Physician 2084P0800X 25MA11226200 NJ
Psychiatry Physician 2084P0800X 281585 NY Primary

Addresses

Primary practice location

109 W 27TH St RM 5S
New York, NY 10001-6208

Mailing address

109 W 27TH St RM 5S
New York, NY 10001-6208
Phone (833) 351-8255

Other practice location 1

150 Riverside Pkwy Ste 115
Fredericksburg, VA 22406-1094
Phone (833) 351-8255

Other practice location 2

1000 Lafayette Blvd Ste 100
Bridgeport, CT 06604-4732
Phone (833) 351-8255

Other practice location 3

53 Frontage Rd Fl 1
Hampton, NJ 08827-4031
Phone (833) 351-8255

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ, NY, VA3 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
I20210830001633 NJ Practitioner - Psychiatry 5991100968 Reassigns benefits to 2 organizations
I20220604000090 NY Practitioner - Psychiatry 5991100968 Reassigns benefits to 1 organization
I20250428000856 VA Practitioner - Psychiatry 5991100968 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Psychiatry
Education
Howard University College of Medicine, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
MCCD New Jersey Psychiatry Services LLCGroup PAC ID 8921452350, 54 clinicians

Practice addresses (Care Compare)

53 Frontage Rd
Hampton, NJ 08827-4031
Phone (833) 351-8255

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
25MA11226200NJMDPsychiatry Physician
281585NYMDPsychiatry Physician

Practice roles

OrganizationSpecialtyStatusNew patients
MCCD New Jersey Psychiatry Services LLC Psychiatry CurrentSince Jan 6, 2025 Accepting new patients
Rutgers Health - Behavioral Health Psychiatry CurrentSince Sep 1, 2021 Accepting new patients
NYU Langone Hospitals CurrentSince Jun 1, 2022 Accepting new patients
MCCD FL Psychiatry Services PA Psychiatry CurrentSince Feb 1, 2025 Accepting new patients
NYU Langone Hospitals Current Accepting new patients
NYU Langone Hospitals CurrentSince Jun 1, 2022 Accepting new patients
Rutgers Health - Behavioral Health Psychiatry Current Accepting new patients
MCCD Psychiatry Services PLLC Psychiatry Past Accepting new patients
Gibson Community Hospital Association Past Accepting new patients
MCCD NJ Psychiatry Services PLLC Psychiatry PastSince Jan 1, 2022 Accepting new patients

Locations

53 Frontage Rd
Fl 1
Hampton, NJ 08827
Phone (908) 386-2572

525 Route 73 N
Ste 117
Marlton, NJ 08053
Phone (609) 200-0444

303 George St
Fl 2
New Brunswick, NJ 08901
Phone (732) 235-6800

183 S Orange Ave
Newark, NJ 07103
Phone (973) 972-0480

671 Hoes Ln W
Rm D3381
Piscataway, NJ 08854
Phone (732) 235-3289

109 W 27th St
Rm 5S
New York, NY 10001
Phone (332) 230-4572

301 E 17th St
New York, NY 10003
Phone (212) 460-0125

14 Wall St
Fl 9
Wall Street, NY 10005
Phone (646) 501-3224

150 Riverside Pkwy
Ste 115
Fredericksburg, VA 22406
Phone (540) 530-5546

Organizations & group practices 10

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1366070400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1746489600000",
    "number": "1578906905",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "109 W 27TH ST RM 5S",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100016208",
            "telephone_number": "833-351-8255",
            "fax_number": "888-815-3583"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "109 W 27TH ST RM 5S",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100016208",
            "telephone_number": "833-351-8255",
            "fax_number": "888-815-3583"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "150 Riverside Pkwy Ste 115",
            "address_purpose": "LOCATION",
            "city": "Fredericksburg",
            "state": "VA",
            "postal_code": "224061094",
            "country_code": "US",
            "telephone_number": "833-351-8255",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1000 Lafayette Blvd Ste 100",
            "address_purpose": "LOCATION",
            "city": "Bridgeport",
            "state": "CT",
            "postal_code": "066044732",
            "country_code": "US",
            "telephone_number": "833-351-8255",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "53 Frontage Rd Fl 1",
            "address_purpose": "LOCATION",
            "city": "Hampton",
            "state": "NJ",
            "postal_code": "088274031",
            "country_code": "US",
            "telephone_number": "833-351-8255",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "DANIELLE",
        "middle_name": "S",
        "name_prefix": "Dr.",
        "credential": "MD MPH",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-04-16",
        "last_updated": "2025-05-06",
        "certification_date": "2025-05-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "NJ",
            "license": "25MA11226200",
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "NY",
            "license": "281585",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in New York, NY

Sources for this page

Verify at the official NPI Registry.