Provider Demographics
NPI:1346588183
Name:JACKSON, EDITH J (NP-C)
Entity Type:Individual
Prefix:MRS
First Name:EDITH
Middle Name:J
Last Name:JACKSON
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:MISS
Other - First Name:EDITH
Other - Middle Name:J
Other - Last Name:SALGADO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:19 CIDER MILL RD
Mailing Address - Street 2:
Mailing Address - City:HAWTHORNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07506-3001
Mailing Address - Country:US
Mailing Address - Phone:973-253-6000
Mailing Address - Fax:973-253-6009
Practice Address - Street 1:1414 MAIN AVE
Practice Address - Street 2:
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07011-2157
Practice Address - Country:US
Practice Address - Phone:973-253-6000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-29
Last Update Date:2018-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00415600363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health