JERREYLL TRAVIS JACKSON (NPI# 1629009576) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1629009576 |
| Entity Type | Individual |
| Full Name | JERREYLL TRAVIS JACKSON |
| Credential | MD |
| Practice Address |
4604 31st Ave Long Island City NY 11103-1842 |
| Practice Telephone | 2128891171 |
| Mailing Telephone | 2128891171 |
| Enumeration Date | 2006-07-06 |
| Last Update Date | 2008-12-08 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207W00000X | Ophthalmology | 043661 | CT | Allopathic & Osteopathic Physicians |
| N | 207W00000X | Ophthalmology | 25MA07982400 | NJ | Allopathic & Osteopathic Physicians |
| Y | 207W00000X | Ophthalmology | 237264 | NY | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NJ | 0168092 | 05 | |
| NY | 2751471 | 05 | |
| NY | 02884251 | 05 |
| Street Address |
4604 31ST AVE |
| City | LONG ISLAND CITY |
| State | NY |
| Zip Code | 11103-1842 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1770579260 | Sachal H Badlani | Internal Medicine | 4604 31st Ave, Long Island City, NY 11103-1842 | 2005-09-21 |
| 1316553589 | Kailin Sofia Cheng | Physician Assistant | 4604 31st Ave, Long Island City, NY 11103-1842 | 2020-09-22 |
| 1568754356 | Andrea Podiatric Care, Pllc | Podiatrist | 4604 31st Ave, Long Island City, NY 11103-1842 | 2011-05-11 |
| 1043501802 | Richard J. Beira, Md PC | Internal Medicine | 4604 31st Ave, Long Island City, NY 11103-1842 | 2011-04-28 |
| 1265551501 | Kiki Kadianakis | Family Medicine | 4604 31st Ave, Suite B, Long Island City, NY 11103-1842 | 2007-03-28 |
| 1366572976 | Biase Lombardi | General Practice | 4604 31st Ave, Long Island City, NY 11103-1842 | 2007-03-06 |
| 1487675104 | Mary Andrea | Podiatrist | 4604 31st Ave, Long Island City, NY 11103-1842 | 2006-07-21 |
| 1588682454 | Boro Medical, P.C. | Chiropractor | 4604 31st Ave, Long Island City, NY 11103-1842 | 2006-07-18 |
| 1295777472 | Emmanuel Hostin | Orthopaedic Surgery | 4604 31st Ave, Long Island City, NY 11103-1842 | 2006-06-12 |
| 1306885439 | Steven Jay Feldstein | Anesthesiology | 4604 31st Ave, Long Island City, NY 11103-1842 | 2006-06-05 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1285248641 | Heather B Keltai | Counselor | 2585 48th St, Astoria, NY 11103 | 2020-09-03 |
| 1174132641 | Mohammed E Yousef | Physical Therapy Assistant | 37 09 Broadway,astoria., Apt 3a, New York, NY 11103 | 2020-07-30 |
| 1588177448 | Jasna Koltovska | Counselor | 3063 38th St Ste B1, Astoria, NY 11103 | 2017-11-14 |
| 1205363884 | Emanuel Papadopoulos | Dentist | 3044 36th St, Astoria, NY 11103 | 2017-05-15 |
| 1174986236 | Joyce Lynn Karpinski | Occupational Therapist | 25-95 45th St, Apt I, Astoria, NY 11103 | 2016-04-05 |
| 1306218847 | Leeat Perelmutter | Social Worker | 2847 34 Street, Apt 17, Astoria, NY 11103 | 2015-10-23 |
| 1740658723 | Cori Shahon | Specialist | 2569 49th Street, Astoria, NY 11103 | 2015-09-09 |
| 1245617539 | Alisa Neziraj | Registered Nurse | 3005 42nd Street, Astoria, NY 11103 | 2015-05-06 |
| 1912399189 | Brad Koegel | Case Manager/Care Coordinator | 30-46 35th Street, Astoria, NY 11103 | 2015-02-25 |
| 1477967826 | Wad Kadi | Pharmacist | 32-87 Steinway St, Long Island City, NY 11103 | 2014-06-13 |
| Find all providers in zip 11103 | ||||
| Taxonomy Code | 207W00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Ophthalmology |
| An ophthalmologist has the knowledge and professional skills needed to provide comprehensive eye and vision care. Ophthalmologists are medically trained to diagnose, monitor and medically or surgically treat all ocular and visual disorders. This includes problems affecting the eye and its component structures, the eyelids, the orbit and the visual pathways. In so doing, an ophthalmologist prescribes vision services, including glasses and contact lenses. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definiton added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Ophthalmology, 2007. http://www.abop.org/. American Osteopathic Board of Ophthalmology and Otolaryngology, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Ophthalmology. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Ophthalmology and Otolaryngology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1760777064 | Sumayya Ahmad | Ophthalmology | 2510 30th Avenue, 4th Floor, C/o Carla Moscoso, Long Island City, NY 11102-1119 | 2011-06-14 |
| 1972800829 | Matthew Feinsod | Ophthalmology | 3711 Queens Blvd, Long Island City, NY 11101-1725 | 2011-02-11 |
| 1760704803 | Theodore Lyu | Ophthalmology | 4310 Crescent St, 2103, Long Island City, NY 11101-4215 | 2010-02-16 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1821607995 | Reginald Camillo Md Pllc | Ophthalmology | 7708 Broadway, Elmhurst, NY 11373-1927 | 2020-07-24 |
| 1366069510 | Rebecca Stein | Ophthalmology | 711 Stewart Ave Ste 160, Garden City, NY 11530-4700 | 2020-07-02 |
| 1548886260 | Bartow Ophthalmology Pllc | Ophthalmology | 2100 Bartow Ave Ste 208, Bronx, NY 10475-4614 | 2020-06-18 |
| 1407485139 | Amy L Kreisberg | Ophthalmology | 25 Byron Ln, Larchmont, NY 10538-1617 | 2020-04-04 |
| 1922634518 | Vision Vibrant Medicine Pllc | Ophthalmology | 837 59th St, Brooklyn, NY 11220-3611 | 2020-03-16 |
| 1710546270 | Ian Chan Md PC | Ophthalmology | 6410 8th Ave # 2a, Brooklyn, NY 11220-4720 | 2019-06-09 |
| 1598320038 | Mid-hudson Family Ophthalmology, Pllc | Ophthalmology | 75 Crystal Run Rd Ste 104a, Middletown, NY 10941-7003 | 2019-05-09 |
| 1144885070 | Nan Alison Sutter Hayworth | Ophthalmology | 214 Mclain St, Mount Kisco, NY 10549-4931 | 2019-05-06 |
| 1104383660 | Shani Golan | Ophthalmology | 325 E 64th St, New York, NY 10065-6709 | 2019-02-20 |
| 1205391224 | Gautam Kamthan Md PC | Ophthalmology | 250 E 39th St Apt 11g, New York, NY 10016-2178 | 2019-02-04 |
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| City | LONG ISLAND CITY |
| Zip Code | 11103 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.