Melanie Wilma Jackson, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

041868 Issued in NY

Practice address

280 Mamaroneck Ave
Suite 305
White Plains, NY 10605-1438

Phone

(914) 949-7417

Fax

(914) 949-7887

NPI assigned

May 15, 2007

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in NY

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1179187200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1841406030",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "280 MAMARONECK AVE",
            "address_2": "SUITE 305",
            "city": "WHITE PLAINS",
            "state": "NY",
            "postal_code": "106051438",
            "telephone_number": "914-949-7417",
            "fax_number": "914-949-7887"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "280 MAMARONECK AVE",
            "address_2": "SUITE 305",
            "city": "WHITE PLAINS",
            "state": "NY",
            "postal_code": "106051438",
            "telephone_number": "914-949-7417",
            "fax_number": "914-949-7887"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "MELANIE",
        "middle_name": "WILMA",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-05-15",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NY",
            "license": "041868",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01115939",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Abigail Cox Ives, MSW
• Michael K Iwaoka, D.D.S.
• Lalitha J Iyer, M.D
• Frederick Izzo
• J&I Pharmacy Corp
• Shemel Jackson
• Christine Jacob
• Maryann Prakash Jacob, M.D.
• Noble Jacob
• Ian Terrell Jacobs, LPN

• General Practice Dentistry in White Plains, NY
• Providers in White Plains, NY by specialty
• General Practice Dentistry in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.