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KEITH RYAN JACKSON MD PC NPI 1326216847


NPI Information

NPI: 1326216847
Provider Name: KEITH RYAN JACKSON MD PC
Classification: Dermatology - 207N00000X
Entity Type: Organization
Address:
11 RALPH PL
SUITE 209
STATEN ISLAND, NY
ZIP 10304
Phone: (718) 727-1331
Get Directions

KEITH RYAN JACKSON MD PC is a dermatology in Staten Island, NY. The provider is a dermatologist is trained to diagnose and treat pediatric and adult patients with benign and malignant disorders of the skin, mouth, external genitalia, hair and nails, as well as a number of sexually transmitted diseases. The dermatologist has had additional training and experience in the diagnosis and treatment of skin cancers, melanomas, moles and other tumors of the skin, the management of contact dermatitis and other allergic and nonallergic skin disorders, and in the recognition of the skin manifestations of systemic (including internal malignancy) and infectious diseases. Dermatologists have special training in dermatopathology and in the surgical techniques used in dermatology. They also have expertise in the management of cosmetic disorders of the skin such as hair loss and scars and the skin changes associated with aging. KEITH RYAN JACKSON MD PC NPI is 1326216847. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

11 RALPH PL
SUITE 209
STATEN ISLAND, NY
ZIP 10304-419
Phone: (718) 727-1331
Fax: (718) 727-2159

The provider's authorized official is Keith Ryan Jackson .
The authorized official title is President and has the following contact phone number (718) 727-1331.

The enumeration date for this NPI number is 2/19/2008 and was last updated on 5/29/2013.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1207N00000XDermatology212165NEW YORKYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
1W31031MEDICARE PINNEW YORK
2H13115MEDICARE UPINNEW YORK
302239307MEDICAIDNEW YORK

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

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