| Doctor Name: | DR. KEITH RYAN JACKSON |
| NPI Number: | 1124116041 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | M.D. |
| License Number: | 212165 |
| Business Practice Address: | 11 Ralph Pl Suite 209 Staten Island, NY - 103044419 |
| Business Phone Number: | 7187271331 |
| Business Fax Number: | 7187272159 |
| Mailing Address: | 11 Ralph Pl, Suite 209 STATEN ISLAND |
| State: | NY |
| Postal Code: | 103044419 |
| Phone Number: | 7187271331 |
| Fax Number: | 7187272159 |
| NPI Enumeration Date: | 10/10/2006 |
| NPI Last Update Date: | 05/28/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 207N00000X |
| License Number: | 212165 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NY |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | Dermatology |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A dermatologist is trained to diagnose and treat pediatric and adult patients with benign and malignant disorders of the skin, mouth, external genitalia, hair and nails, as well as a number of sexually transmitted diseases. The dermatologist has had additional training and experience in the diagnosis and treatment of skin cancers, melanomas, moles and other tumors of the skin, the management of contact dermatitis and other allergic and nonallergic skin disorders, and in the recognition of the skin manifestations of systemic (including internal malignancy) and infectious diseases. Dermatologists have special training in dermatopathology and in the surgical techniques used in dermatology. They also have expertise in the management of cosmetic disorders of the skin such as hair loss and scars and the skin changes associated with aging. |