COLLEEN A JACKSON (NPI# 1669629275) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1669629275 |
| Entity Type | Individual |
| Full Name | COLLEEN A JACKSON |
| Practice Address |
101 Hospital Rd Patchogue NY 11772-4870 |
| Practice Telephone | 6316547236 |
| Enumeration Date | 2008-08-26 |
| Last Update Date | 2008-08-26 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 133NN1002X |
Nutritionist Specialization: Nutrition, Education |
004661 | NY | Dietary & Nutritional Service Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1447762844 | Colleen Jackson | Occupational Therapy Assistant | 8011 Elkhart Ave, Lubbock, TX 79424-2615 | 2017-10-26 |
| 1699317263 | Colleen M Jackson | Counselor | 1136 S Delano Ct W Ste B201, Chicago, IL 60605-3734 | 2019-10-15 |
| 1952765661 | Colleen E Jackson | Clinical Neuropsychologist | 150 S Huntington Ave, Boston Va Medical Center (116b), Boston, MA 02130-4817 | 2016-04-08 |
| 1801269840 | Colleen Q Jackson | Licensed Practical Nurse | 224 Harrison St, Suite 680, Syracuse, NY 13202-3056 | 2015-11-12 |
| 1134331259 | Colleen Delores Jackson | Nurse Practitioner | 8700 Beverly Blvd, Thalians 2w, Rm 218, West Hollywood, CA 90048-1804 | 2007-05-03 |
| 1346354073 | Colleen Marie Jackson | Durable Medical Equipment & Medical Supplies | 417 E Baltimore St, Unit A, Taneytown, MD 21787-2300 | 2006-08-19 |
| Street Address |
101 HOSPITAL RD |
| City | PATCHOGUE |
| State | NY |
| Zip Code | 11772-4870 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1619523107 | Meghan Cabrera | Nurse Practitioner | 101 Hospital Rd, Patchogue, NY 11772-4870 | 2019-08-12 |
| 1679049456 | Shannon Faith Landry | Physician Assistant | 101 Hospital Rd, Patchogue, NY 11772 | 2018-10-18 |
| 1306311600 | Adrian S Krueger | Physician Assistant | 101 Hospital Rd, Patchogue, NY 11772-4870 | 2018-10-12 |
| 1326523382 | Brandon Lee | Emergency Medicine | 101 Hospital Rd, Patchogue, NY 11772-4897 | 2018-09-26 |
| 1043791882 | Kathryn Elizabeth Walton | Physician Assistant | 101 Hospital Rd, Patchogue, NY 11772-4870 | 2018-08-28 |
| 1508346248 | Brookhaven Memorial Hospital Medical Center, Inc. | Emergency Medicine | 101 Hospital Rd, Patchogue, NY 11772-4870 | 2018-08-21 |
| 1043799513 | Hospitalist Medicine Physicians of New York-tcg, PC | Internal Medicine | 101 Hospital Rd, Patchogue, NY 11772-4870 | 2018-08-07 |
| 1013496579 | Courtney Bofinger | Physician Assistant | 101 Hospital Rd, Patchogue, NY 11772-4870 | 2018-08-07 |
| 1366920993 | Hospitalist Medicine Physician of New York - Patchogue, PC | Internal Medicine | 101 Hospital Rd, Patchogue, NY 11772-4870 | 2018-08-06 |
| 1750868824 | Michelle Wintjen | Nurse Practitioner | 101 Hospital Rd, Patchogue, NY 11772-4897 | 2018-07-23 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1205447224 | Amita Vipul Patel | Nurse Practitioner | Longlsland Community Hospital, 101 Hospital Rd, Patchogue, NY 11772 | 2020-08-13 |
| 1609491968 | Sanjib Dey | Family Medicine | Brookhaven Nephrology Associates, 260 E. Patchogue-yaphank Rd., Patchogue, NY 11772 | 2020-06-12 |
| 1992297204 | Camila Bueno-sanchez | Student in an Organized Health Care Education/Training Program | 676 S Country Rd, East Patchogue, NY 11772 | 2018-06-01 |
| 1184115859 | Premier Endodontics of Patchogue | Dentist | 44 Medford Avenue, Patchogue, NY 11772 | 2018-05-29 |
| 1801386453 | Franklin Ikechukwu Ugbode | Student in an Organized Health Care Education/Training Program | 100 Hospital Road Suite 201, Patchogue, NY 11772 | 2018-05-18 |
| 1508372335 | Stephanie Vanschaick | Counselor | 450 Waverly Ave Ste 11, Patchogue, NY 11772 | 2017-12-15 |
| 1578074498 | Chrystal Lee Curran | Specialist | 1116 Main Road, Aquebogue, NY 11772 | 2017-10-18 |
| 1013457712 | Candyce Fahner | Registered Nurse | 22 Haig Ave, E Patchogue, NY 11772 | 2017-02-28 |
| 1992251631 | Vanessa Lynn Petoello | Nurse Practitioner | 107 N/ Ocean Ave, Suite G, Patchogue, NY 11772 | 2016-09-01 |
| 1811343809 | Andrew Vanderlofske | Nurse Practitioner | 144 North Ocean Avenue, Patchogue, NY 11772 | 2016-05-09 |
| Find all providers in zip 11772 | ||||
| Taxonomy Code | 133NN1002X |
| Grouping | Dietary & Nutritional Service Providers |
| Classification | Nutritionist |
| Specialization | Nutrition, Education |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1952908832 | Natalie Rae Palumbo | Nutritionist | 380 Hill St, Southampton, NY 11968-5327 | 2020-10-05 |
| 1912516972 | Sophia Aslanis | Nutritionist | 57 W 57th St Ste 900, New York, NY 10019-2813 | 2020-07-27 |
| 1225652357 | Amanda Dipietro | Nutritionist | 123 Hope St Apt 2l, Brooklyn, NY 11211-3984 | 2020-06-04 |
| 1366063232 | Nyc Naturally, Inc. | Nutritionist | 792 Route 35, Cross River, NY 10518-1118 | 2020-05-02 |
| 1992324578 | Kelly Brock | Nutritionist | 1 Ireland Pl, Amityville, NY 11701-2955 | 2020-04-13 |
| 1740828847 | Evelina Sodt | Nutritionist | 65 Main St Fl 1, Warwick, NY 10990-1346 | 2019-12-19 |
| 1891332276 | Emily Wallis | Nutritionist | 315 Oakwood St, Rome, NY 13440-3806 | 2019-12-05 |
| 1639713969 | Ilana Lauer | Nutritionist | 759 Wilson Ct, Valley Stream, NY 11581-3531 | 2019-10-30 |
| 1558917591 | Helenica Yusuf | Nutritionist | 1 Brookdale Plaza 2acc- Q Rm 229-e, Brooklyn, NY 11212-3198 | 2019-08-15 |
| 1386101178 | Melissa Danielle O'shea | Nutritionist | 109 Manitou Trl, Kings Park, NY 11754-4550 | 2019-02-27 |
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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.