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JERREYLL TRAVIS JACKSON MD
NPI 1629009576
Ophthalmology in Long Island City, NY

Active since July 06, 2006
4604 31ST AVE, LONG ISLAND CITY, NY 11103(212) 889-1171 Get Directions Write a Review

NPPES record last updated: December 8, 2008. Verified against the NPPES registry weekly; last sync: July 26, 2026.

About Jerreyll Travis Jackson Md NPPES

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

JERREYLL TRAVIS JACKSON MD (NPI 1629009576) is an individual ophthalmology provider in Long Island City, New York, licensed in New York (237264) and active in the NPI registry since July 2006.

NPPES Registry Identity

NPI1629009576
Entity TypeIndividualMale
Primary Taxonomy207W00000X
Provider Legal NameJERREYLL TRAVIS JACKSONCredential: MD
Location Address4604 31ST AVELong Island City, NY 11103-1842
Mailing Address4604 31st AveLong Island City, NY 11103-1842 · (212) 889-1171
Phone(212) 889-1171
Sole ProprietorYes
Enumeration DateJuly 6, 2006
Last NPPES UpdateDecember 8, 2008
✔ NPI 1629009576 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyOphthalmologyAllopathic & Osteopathic Physicians
Taxonomy Code207W00000X
Licenses✔ Licensed in NY · 237264✔ Licensed in NJ · 25MA07982400✔ Licensed in CT · 043661
Definition
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.
4604 31ST AVE, Long Island City, NY 11103
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Other Identifiers 7

Medicaid0168092NJ
Medicare PIN095704CX9NJ
Medicare UPINH37399NY
Medicaid02884251NY
Medicaid2751471NY
Medicare PIN095704T64NJ
Medicare PIN521A51NY

Other Providers at the Same Location NPPES 18

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

DR. ARKADIY SABZANOV M.D.
Anesthesiology
4604 31ST AVE
ASTORIA, NY 11103
Queens County (718) 545-5050
NEW YORK ANESTHESIA, PC
Anesthesiology
4604 31ST AVE
ASTORIA, NY 11103
Queens County (718) 545-5050
RICHARD J. BEIRA, MD PC
Family Medicine
4604 31ST AVE
LONG ISLAND CITY, NY 11103
Queens County (914) 629-0989
PAINFREE IV LTD
Anesthesiology
4604 31ST AVE
ASTORIA, NY 11103
Queens County (718) 222-5999
NEW YORK INTERNAL MEDICINE, PC
Internal Medicine
4604 31ST AVE
ASTORIA, NY 11103
Queens County (718) 746-9495
DR. KIKI KADIANAKIS D.O.
Family Medicine
4604 31ST AVE, SUITE B
LONG ISLAND CITY, NY 11103
Queens County (718) 545-2100
NEW YORK SURGERY CENTER QUEENS, LLC
Clinic/Center (Ambulatory Surgical)
4604 31ST AVE
ASTORIA, NY 11103
Queens County (718) 545-5050
DR. JOSHUA BONSELL M.D.
Anesthesiology (Pain Medicine)
4604 31ST AVE
ASTORIA, NY 11103
Queens County (718) 545-5034

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 Jerreyll Jackson's NPI number?

The NPI number for Jerreyll Jackson is 1629009576. It was assigned to this individual provider in the NPPES registry on July 6, 2006.

Where is Jerreyll Jackson located?

Jerreyll Jackson practices at 4604 31st Ave, Long Island City, NY 11103. The listed phone number is (212) 889-1171.

What is Jerreyll Jackson's specialty?

The primary specialty registered for this NPI is Ophthalmology with taxonomy code 207W00000X.

When was this NPI record last updated?

The NPPES record for Jerreyll Jackson was last updated on December 8, 2008. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 17 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.