NPI 1245993450

Jackson Topaz

Practitioner Peer Specialist Coram, NY

Practice location

Address: 3600 Route 112, Coram, NY 11727-4116
Phone: (631) 920-8500
Mailing address: 14202 20th Ave Fl 3, Flushing, NY 11351-3000

Registered specialties

Peer Specialist Primary

Other Service Providers Taxonomy 175T00000X

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Registry record

NPI: 1245993450
Entity type: Individual
Sex (as registered): Male
NPI issued: 15 Oct 2021
Record last updated: 15 Oct 2021

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.