Provider Demographics
NPI:1043617194
Name:JACKSON, RISHONA (MS ED)
Entity Type:Individual
Prefix:MRS
First Name:RISHONA
Middle Name:
Last Name:JACKSON
Suffix:
Gender:F
Credentials:MS ED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5201 BEVERLEY RD
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11203-5324
Mailing Address - Country:US
Mailing Address - Phone:347-902-1389
Mailing Address - Fax:
Practice Address - Street 1:19 W 21ST ST RM 701
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10010-6855
Practice Address - Country:US
Practice Address - Phone:646-230-8190
Practice Address - Fax:646-230-8185
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-04
Last Update Date:2014-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY32139174H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator