Jackson, Keith Ryan
Jackson, Keith Ryan is an sole proprietor health care provider with primary practice located at 11 Ralph Pl Suite 209, Staten Island NY 10304-4419. He recently has only one registered license in Allopathic & Osteopathic Physicians / Dermatology, which is considered as his primary health care specialty. Jackson, Keith Ryan can be contacted via phone (718) 727-1331.Contact Information
Primary practice address
11 Ralph Pl Suite 209
Staten Island NY 10304-4419
Phone: (718) 727-1331
Fax: (718) 727-2159
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Dermatology | 207N00000X | 212165 | New York |
Profile Details
| NPI number | 1124116041 |
|---|---|
| LBN Legal business name | Jackson, Keith Ryan |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Oct 10th, 2006 |
| Last updated | May 28th, 2013 - about 11 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 | 1124116041 | NPPES |
| New York | MEDICAID | 02239307 |
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