Allison Jackson
Physician Assistant in Bronx, NY. Individual provider (NPI-1).
NPI number1164035978
StatusActive
Last updated in NPPESJan 10, 2021
Details
- NPI
- 1164035978
- Entity type
- Individual (NPI-1)
- Name
- Allison Jackson
- Sex
- Female
- Sole proprietor
- No
- Enumeration date
- Aug 31, 2020
- Certification date
- Nov 5, 2020
- Last updated
- Jan 10, 2021
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 363A00000X | Physician Assistant | – | – | Yes |
Practice location
111 E 210th StBronx, NY 10467-2401
Phone 845-628-5688
Mailing address
4 Fawn DrMahopac, NY 10541-2032
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