Provider Demographics
NPI:1154395788
Name:JACKSON, ALISON M (PA-C)
Entity type:Individual
Prefix:
First Name:ALISON
Middle Name:M
Last Name:JACKSON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1554
Mailing Address - Street 2:
Mailing Address - City:STONY BROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11790-0988
Mailing Address - Country:US
Mailing Address - Phone:631-444-0650
Mailing Address - Fax:631-638-4170
Practice Address - Street 1:23 S HOWELL AVE
Practice Address - Street 2:STONY BROOK MEDICINE - VASCULAR SURGERY
Practice Address - City:CENTEREACH
Practice Address - State:NY
Practice Address - Zip Code:11720-4445
Practice Address - Country:US
Practice Address - Phone:631-638-1670
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-13
Last Update Date:2016-06-07
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant