Richard T Jackson LLC
Psychiatry & Neurology, Neurology in Clifton Park, NY. Organization (NPI-2).
NPI number1164055893
StatusActive
Last updated in NPPESJul 8, 2021
Details
- NPI
- 1164055893
- Entity type
- Organization (NPI-2)
- Legal business name
- Richard T Jackson LLC
- Organization subpart
- No
- Enumeration date
- Feb 21, 2020
- Certification date
- Jul 8, 2021
- Last updated
- Jul 8, 2021
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 2084N0400X | Psychiatry & Neurology, Neurology | – | – | Yes |
Other names
- Saratoga Headache Center (Doing Business As)
Practice location
7 Southside DrClifton Park, NY 12065-3887
Phone 646-957-7648
Mailing address
7 Southside DrClifton Park, NY 12065-3887
Phone 518-709-0005 · Fax 518-280-2275
Other practice locations
3 Lear Jet Ln Ste 203
Latham, NY 12110-2322
Latham, NY 12110-2322
Phone 518-258-4033 · Fax 518-280-2275
Authorized official
Richard Jackson
Owner
5187090005
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