Jackson, Douglas T
Jackson, Douglas T is an individual health care provider with primary practice located at 150 Bargen St F 102, Newark NJ 07103. He recently has only one registered license in Allopathic & Osteopathic Physicians / Critical Care Medicine, which is considered as his primary health care specialty. Jackson, Douglas T can be contacted via phone (973) 972-3555.Contact Information
Primary practice address
150 Bargen St F 102
Newark NJ 07103
Phone: (973) 972-3555
Fax: (973) 972-3510
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Critical Care Medicine | 207LC0200X | 25MA06601400 | New Jersey |
Profile Details
| NPI number | 1962472407 |
|---|---|
| LBN Legal business name | Jackson, Douglas T |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Jan 26th, 2006 |
| Last updated | Jul 8th, 2007 - about 17 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1962472407 | NPPES |
| New Jersey | MEDICAID | 6716407 |
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