1902441165 NPI number — AVRIL JACKSON, LPN, P.C.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902441165 NPI number — AVRIL JACKSON, LPN, P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AVRIL JACKSON, LPN, P.C.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1902441165
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/12/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
50 MAIN STREET STE 1000
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WHITE PLAINS
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10606
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
914-682-2048
Provider Business Mailing Address Fax Number:
914-682-7784

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
50 MAIN ST STE 1000
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WHITE PLAINS
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10606-1900
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
914-682-2048
Provider Business Practice Location Address Fax Number:
914-682-7784
Provider Enumeration Date:
11/12/2019

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
JACKSON
Authorized Official First Name:
AVRIL
Authorized Official Middle Name:
D
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
914-682-2048

Provider Taxonomy Codes

  • Taxonomy code: 164W00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)