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Contact Information

DOUGLAS T JACKSON, MD
150 BARGEN ST
F 102
NEWARK, NJ07103
 Phone: 973-972-3555
 Fax: 973-972-3510
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Critical Care Medicine

207LC0200X 05 Physician/Anesthesiology
Indicates primary specialty

NPI Profile & details for DOUGLAS T JACKSON · (Male)

NPI # 1962472407
Status Active
Credentials MD
Entity Individual
Enumeration date 01/26/2006
Last updated 07/08/2007 - About 19 years ago
Sole proprietor 1 Not specified
Identifiers
  • NJ License # 25MA06601400
  • NJ Medicaid 6716407
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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