NPI 1326216847

Keith Ryan Jackson MD PC

Organisation Dermatology Physician Staten Island, NY

Practice location

Address: 11 Ralph Pl Suite 209, Staten Island, NY 10304-4419
Phone: (718) 727-1331
Fax: (718) 727-2159

Authorised official

Name: Keith Ryan Jackson
Title: President
Phone: (718) 727-1331

Registered specialties

Dermatology Physician Primary

Allopathic & Osteopathic Physicians Taxonomy 207N00000X Licence 212165 (NY)

Other Dermatology providers in New York →

Registry record

NPI: 1326216847
Entity type: Organization
NPI issued: 19 Feb 2008
Record last updated: 29 May 2013

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.