Jackson, Jerreyll Travis
Jackson, Jerreyll Travis is an sole proprietor health care provider with primary practice located at 4604 31St Ave , Long Island City NY 11103-1842. He recently has only one registered license in Allopathic & Osteopathic Physicians / Ophthalmology, which is considered as his primary health care specialty. Jackson, Jerreyll Travis can be contacted via phone (212) 889-1171.Contact Information
Primary practice address
4604 31St Ave
Long Island City NY 11103-1842
Phone: (212) 889-1171
Fax:
Website:
Health care specialties
Specialty | Code | License # | State |
---|---|---|---|
Allopathic & Osteopathic Physicians / Ophthalmology | 207W00000X | 25MA07982400 | New Jersey |
Allopathic & Osteopathic Physicians / Ophthalmology | 207W00000X | 043661 | Connecticut |
Allopathic & Osteopathic Physicians / Ophthalmology | 207W00000X | 237264 | New York |
Profile Details
NPI number | 1629009576 |
---|---|
LBN Legal business name | Jackson, Jerreyll Travis |
Credentials | Doctor of Medicine (MD) |
Entity | Individual |
Sole proprietor 1 | Yes |
Enumeration date | Jul 6th, 2006 |
Last updated | Dec 8th, 2008 - about 16 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 | 1629009576 | NPPES |
New York | MEDICAID | 2751471 | |
New York | MEDICAID | 02884251 | |
New York | MEDICAID | 0168092 |
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