Avila T Jackson, DPM

Primary specialty

Primary Podiatric Medicine PodiatristTaxonomy code 213EP1101X

License

006459 Issued in NY

Practice address

86-41 Lefferts Blvd.
Richmond Hill, NY 11418

Phone

(718) 849-3338

Fax

(718) 849-3166

NPI assigned

Jul 13, 2007

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other names 1

• Avia Terrell Jackson Other name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

HHS exclusion list flag

Flagged The directory lists this NPI on an HHS exclusion list. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.

State licenses

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

{
    "created_epoch": "1184284800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1338422400000",
    "number": "1811196488",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "86-41 LEFFERTS BLVD",
            "city": "RICHMOND HILL",
            "state": "NY",
            "postal_code": "11418",
            "telephone_number": "718-849-3338",
            "fax_number": "718-849-3166"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "86-41 LEFFERTS BLVD.",
            "city": "RICHMOND HILL",
            "state": "NY",
            "postal_code": "11418",
            "telephone_number": "718-849-3338",
            "fax_number": "718-849-3166"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "AVILA",
        "middle_name": "T",
        "credential": "DPM",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-07-13",
        "last_updated": "2012-05-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "213EP1101X",
            "taxonomy_group": "",
            "desc": "Podiatrist, Primary Podiatric Medicine",
            "state": "MI",
            "license": "5901002248",
            "primary": false
        },
        {
            "code": "213EP1101X",
            "taxonomy_group": "",
            "desc": "Podiatrist, Primary Podiatric Medicine",
            "state": "NY",
            "license": "006459",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "AVIA",
            "last_name": "JACKSON",
            "middle_name": "TERRELL",
            "credential": "DPM.",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Island Musculoskeletal Care MD PC
• Island Musculoskeletal Care, M.D., P.C.
• Ike Iwu
• Avraham Izrailov, DO
• Sharona Izrailova
• Christopher Jackson
• Darrick K Jagbandhansingh, PTA
• Sophia Mita Jagroop, M. D
• Aishvarya Jain
• Glenn Jakobsen, D.O.

• Primary Podiatric Medicine Podiatrist in Richmond Hill, NY
• Providers in Richmond Hill, NY by specialty
• Primary Podiatric Medicine Podiatrist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 31, 2012; 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.