Doctor Name: | LISA NICOLE JACKSON |
NPI Number: | 1487844973 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | M.D. |
License Number: | 60 245188 |
Business Practice Address: | 89-06 135th St Room 6a Jamaica, NY - 11418 |
Business Phone Number: | 7182066808 |
Business Fax Number: | |
Mailing Address: | 354 E 91st St, Apt 1805 NEW YORK |
State: | NY |
Postal Code: | 101285354 |
Phone Number: | 3122136402 |
Fax Number: | |
NPI Enumeration Date: | 07/31/2007 |
NPI Last Update Date: | 07/31/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 207V00000X |
License Number: | 60 245188 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NY |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | Obstetrics & Gynecology |
Taxonomy Specialization: | |
Taxonomy Definition: | An obstetrician/gynecologist possesses special knowledge, skills and professional capability in the medical and surgical care of the female reproductive system and associated disorders. This physician serves as a consultant to other physicians and as a primary physician for women. |