| Provider / Organization | NPI | Date Certified |
|---|---|---|
| KIM B JACKSON | 1003415464 | 2020-10-18 |
Kim B Jackson is registered with the National Plan and Provider Enumeration System and has been issued an National Provider Identifier (NPI) of 1003415464. Registration indicates Kim B Jackson is a provider of services with a specialization in Respiratory, Developmental, Rehabilitative and Restorative Service Providers, Massage Therapist (Massage Therapist, ) (Massage Therapist, Respiratory, Developmental, Rehabilitative and Restorative Service Providers)
| Entity Type | Individual |
| Provider Name | Kim B Jackson |
| Practice Office Address | 29 GLEN COVE AVE STE 212 GLEN COVE, NY US |
| Practice Office Telephone | 5163847670 |
| Mailing Address | 1360 C ST ELMONT, NY 110033816 US |
| Business Telephone | 5163847670 |
| email [none] | [email protected] | Health Information Exchange (HIE) |
| Code | Practice | License No State |
|---|---|---|
| 225700000X PRIMARY | Respiratory, Developmental, Rehabilitative and Restorative Service Providers Massage Therapist Massage Therapist Massage Therapist Respiratory, Developmental, Rehabilitative and Restorative Service Providers | 028858
NY |