Mary J Jackson, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

154924 Issued in NY

Practice address

308 W Seneca St
Manlius, NY 13104-2318

Phone

(315) 682-5080

Fax

(315) 682-8847

NPI assigned

Dec 14, 2005

Last updated

Jun 8, 2009By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

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.

• Cap Medical, LLC

  • Family Medicine Physician
  • New Hartford, NY
  • NPI 1730346115
  NPD (past)
• Loretto Rest Realty Corporation

  • Clinic/Center
  • Syracuse, NY
  • NPI 1548366271
  NPD (past)

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

{
    "created_epoch": "1134518400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1244419200000",
    "number": "1609851443",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1001 W FAYETTE ST",
            "address_2": "STE 400",
            "city": "SYRACUSE",
            "state": "NY",
            "postal_code": "132042859",
            "telephone_number": "315-472-1488",
            "fax_number": "315-472-8060"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "308 W SENECA ST",
            "city": "MANLIUS",
            "state": "NY",
            "postal_code": "131042318",
            "telephone_number": "315-682-5080",
            "fax_number": "315-682-8847"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "MARY",
        "middle_name": "J",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-12-14",
        "last_updated": "2009-06-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NY",
            "license": "154924",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lawrence B Hurwitz, MD
• Kaitlyn Elizabeth Huysman, RPA-C
• Immediate Medical Care of Cny, PC
• Indeed Wellness, LLC (inDeed Wellness)
• J. Christopher Stringer, MD PLLC
• Sandra Renee Jackson, PT, DPT, CHT
• Jason D. Henderson, DDS PC
• Jean Howard
• Susan Marjorie Jenner, NP
• Barbara Gwen Jones

• Family Medicine Physician in Manlius, NY
• Providers in Manlius, NY by specialty
• Family Medicine Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 8, 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.