Provider Demographics
NPI:1306820675
Name:JACKSON-POWELL, GUILLERMINA (MD)
Entity Type:Individual
Prefix:DR
First Name:GUILLERMINA
Middle Name:
Last Name:JACKSON-POWELL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 COMMERCE DR
Mailing Address - Street 2:
Mailing Address - City:NEW ROCHELLE
Mailing Address - State:NY
Mailing Address - Zip Code:10801-5214
Mailing Address - Country:US
Mailing Address - Phone:914-637-3510
Mailing Address - Fax:914-819-0061
Practice Address - Street 1:10 COMMERCE DR
Practice Address - Street 2:
Practice Address - City:NEW ROCHELLE
Practice Address - State:NY
Practice Address - Zip Code:10801-5214
Practice Address - Country:US
Practice Address - Phone:914-637-3510
Practice Address - Fax:914-819-0061
Is Sole Proprietor?:No
Enumeration Date:2005-12-01
Last Update Date:2008-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY193643207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01810439Medicaid
NY89A231Medicare PIN
NY89A23YRXP1Medicare PIN
NJ057608RJ0Medicare PIN
NY89A23ZT5H1Medicare PIN
NY89A23ZXWW1Medicare PIN
NY0650AAMedicare PIN
NYG65163Medicare UPIN