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MARILYN M. JACKSON, M.D., M.P.H., PLLC
NPI 1053462986
Internal Medicine in New York, NY

Active since January 16, 2007CLIA 33D1070793 · Waiver
421 W 57TH ST, SUITE B, NEW YORK, NY 10019(212) 247-8023(212) 247-8024 Get Directions Write a Review

NPPES record last updated: October 15, 2007. Verified against the NPPES registry weekly; last sync: August 16, 2026.

About Marilyn M. Jackson, M.d., M.p.h., Pllc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MARILYN M. JACKSON, M.D., M.P.H., PLLC (NPI 1053462986) is a healthcare organization registered as an internal medicine in New York, New York and active in the NPI registry since January 2007. The organization holds a CLIA Waiver certificate valid through July 9, 2027 and lists Marilyn M. Jackson, Ceo, as its authorized official.

NPPES Registry Identity

NPI1053462986
Entity TypeOrganization
Primary Taxonomy207R00000X
Legal Business NameMARILYN M. JACKSON, M.D., M.P.H., PLLC
Location Address421 W 57TH ST, SUITE BNew York, NY 10019-1763
Mailing Address421 W 57th St, Suite BNew York, NY 10019-1763 · (212) 247-8023 · Fax (212) 247-8024
Phone(212) 247-8023
Fax(212) 247-8024
Organization SubpartNo
Authorized OfficialMarilyn M. JacksonCeo · (917) 549-5268
Enumeration DateJanuary 16, 2007
Last NPPES UpdateOctober 15, 2007
✔ NPI 1053462986 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyInternal MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207R00000X
License✔ Licensed in NY · 189136
Definition
A physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults and the elderly. Internists are trained in the diagnosis and treatment of cancer, infections and diseases affecting the heart, blood, kidneys, joints and digestive, respiratory and vascular systems. They are also trained in the essentials of primary care internal medicine, which incorporates an understanding of disease prevention, wellness, substance abuse, mental health and effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs.
421 W 57TH ST, New York, NY 10019
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Other Identifiers 3

Medicaid01447254NY
Medicare PINWANW41NY
Medicare UPINF65129NY

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 33D1070793

Marilyn M Jackson MD Mph PLLC · New York, NY
Active · expires Jul 9, 2027
CLIA Number33D1070793
Laboratory TypePhysician Office
Certificate Effective DateJuly 10, 2025
Certificate Expiration DateJuly 9, 2027
Laboratory DirectorMarilyn M. Jackson
Laboratory Phone(212) 247-8023
Laboratory LocationMarilyn M Jackson MD Mph PLLC421 West 57th Street Ste B, New York, NY 10019
CLIA data matches this NPI record on: Address Phone
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 2

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

DR. RONALD BIRNBAUM D.D.S., M.P.H.
Dentist
421 W 57TH ST
NEW YORK, NY 10019
New York County (212) 203-3502
DR. MARILYN M. JACKSON M.D
Internal Medicine
421 W 57TH ST, SUITE B
NEW YORK, NY 10019
New York County (212) 247-8023

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Marilyn M. Jackson, M.D., M.P.H., PLLC's NPI number?

The NPI number for Marilyn M. Jackson, M.D., M.P.H., PLLC is 1053462986. It was assigned to this organization in the NPPES registry on January 16, 2007.

Where is Marilyn M. Jackson, M.D., M.P.H., PLLC located?

Marilyn M. Jackson, M.D., M.P.H., PLLC is located at 421 W 57th St Suite B, New York, NY 10019. The listed phone number is (212) 247-8023.

What is Marilyn M. Jackson, M.D., M.P.H., PLLC's specialty?

The primary specialty registered for this NPI is Internal Medicine with taxonomy code 207R00000X.

Does Marilyn M. Jackson, M.D., M.P.H., PLLC hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 33D1070793) is associated with this NPI, valid through July 9, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Marilyn M. Jackson, M.D., M.P.H., PLLC was last updated on October 15, 2007. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 18 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.