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Contact Information

MARY B JACKSON, CERTIFIED DIETITIAN/
33 FULTON PLAZA
MIDDLETOWN, NY10940
 Phone: 845-346-1300
 Fax: 845-346-1298
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Nutritionist

133N00000X
Indicates primary specialty

NPI Profile & details for MARY B JACKSON · (Female)

NPI Number 1376835298
Status Active
Credentials CERTIFIED DIETITIAN/
Entity Individual
Enumeration date 05/11/2011
Last updated 05/11/2011 - About 15 years ago
Sole proprietor 1 Yes
Identifiers
  • NY License # 004474-1
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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