Data from the NPPES registry. May not reflect recent changes — verify at nppes.cms.hhs.gov.
MISS NICOLE JACKSON
Active Sole ProprietorMISS NICOLE JACKSON is a Substance Use Disorder Rehabilitation Facility healthcare provider located in SMITHTOWN, New York. NPI 1972977825 is currently active in the NPPES registry. Verify at CMS.
Substance Use Disorder Rehabilitation Facility · SMITHTOWN, NY
Registration Details
- NPI Number
- 1972977825
- Provider Type
- Individual
- Gender
- Female
- NPI Issued
- Nov 16, 2015 (10.782885478023 yrs)
- Last Updated
- Nov 16, 2015
- License
-
089076 (NY)
- Sole Proprietor
- Yes
Practice Information
- Address
-
11 ROUTE 111SMITHTOWN, NY, 117873753Browse NY providers · Browse ZIP 11787
- Phone
- 6319208300
- Primary Specialty
-
Substance Use Disorder Rehabilitation Facility
261QR0405X
Data sourced from the NPPES National Provider Identifier registry. This information is for informational purposes only and is not a substitute for verifying credentials with the appropriate licensing authority. For official verification, use the NPPES NPI Registry or the relevant state medical board.