Ulysses Jackson

NPI 1376962647 - Counselor - 101YA0400X

NPI Details
NPI 1376962647
Gender Male
Enumeration Date 04/15/2014
Last Updated 04/15/2014
Entity Type Individual
Active Over 2 years ago
Practice Location
770 GRAND BLVD
DEER PARK NY, 11729-5750, US
Phone (631) 392-4357
Fax (631) 392-4358
Business Location
770 GRAND BLVD
DEER PARK NY, 11729-5750, US
Phone (631) 392-4357
Fax (631) 392-4358
Toxanomy
Taxonomy Code 101YA0400X
License State New York
License Number 24980
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According to our database, Ulysses Jackson NPI is 1376962647, taxonomy code is 101YA0400X and license number is 24980, license state is located at New York. Ulysses Jackson physically located at 770 Grand Blvd, Deer Park NY, 11729-5750. NPI Number Ulysses Jackson has the Individual type.

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1376962647 NPI number is provided on an as is basis without warranty of any kind. 1376962647 is maintained by the National Plan & Provider Enumeration System. The contents of Ulysses Jackson are for informational purposes only.