Teresa Alice Jackson, MSED

Primary specialty

ContractorTaxonomy code 171W00000X

License

717251962 Issued in NY

Practice address

41 Green St
Valley Stream, NY 11580-4815

Phone

(516) 285-6388

Fax

(516) 285-6388

NPI assigned

Jun 11, 2012

Sex

Female

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1339372800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1339372800000",
    "number": "1972865442",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "41 GREEN ST",
            "city": "VALLEY STREAM",
            "state": "NY",
            "postal_code": "115804815"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "41 GREEN ST",
            "city": "VALLEY STREAM",
            "state": "NY",
            "postal_code": "115804815",
            "telephone_number": "516-285-6388",
            "fax_number": "516-285-6388"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "TERESA",
        "middle_name": "ALICE",
        "name_prefix": "Ms.",
        "credential": "MSED",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-06-11",
        "last_updated": "2012-06-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "171W00000X",
            "taxonomy_group": "",
            "desc": "Contractor",
            "state": "NY",
            "license": "717251962",
            "primary": true
        },
        {
            "code": "171W00000X",
            "taxonomy_group": "",
            "desc": "Contractor",
            "state": "NY",
            "license": "486110931",
            "primary": false
        },
        {
            "code": "171W00000X",
            "taxonomy_group": "",
            "desc": "Contractor",
            "state": "NY",
            "license": "486112931",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jack M. Rubenstein, MD
• Keshia Jackman
• Akilia Jackson Semoy
• Nadia Jackson, MSED
• Serida Marie Jackson, LPN
• Asha Jacob, D.P.T., W.C.C.
• Alexa Jaeger
• Chad Jaggon
• Rehana Jagnandan, PHARMD
• Jaime Gamatero PT P.C.

• Contractor in Valley Stream, NY
• Providers in Valley Stream, NY by specialty
• Contractor in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 11, 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.