DR. LELAND JAY JACKSON (NPI# 1386616472) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1386616472 |
| Entity Type | Individual |
| Full Name | DR. LELAND JAY JACKSON |
| Credential | MD |
| Practice Address |
5006 W Genesee St Camillus NY 13031-2326 |
| Practice Telephone | 3152342342 |
| Practice Fax Number | 3152340697 |
| Mailing Telephone | 3152342342 |
| Mailing Fax Number | 3152340697 |
| Enumeration Date | 2006-02-03 |
| Last Update Date | 2009-08-27 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207Q00000X | Family Medicine | 171536 | NY | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| DEA | BJ1829893 | 01 | |
| NY | STATE LICENSE NUMBER | 171536 | 01 |
| NY | 01348347 | 05 |
| Street Address |
5006 W GENESEE ST |
| City | CAMILLUS |
| State | NY |
| Zip Code | 13031-2326 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1851559710 | Kimberly Jean Sandford | Nurse Practitioner | 5006 W Genesee St, Camillus, NY 13031-2326 | 2008-05-28 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1194361337 | Marsha Reedy | Registered Nurse | Baldwinsville Schools, 29 East Oneida Street, Baldwinsville, NY 13031 | 2019-11-22 |
| 1821632167 | Romans Soltani Dentistry, Pllc | Dentist | 5426 W. Genesee Street, Camillus, NY 13031 | 2019-10-30 |
| 1174178859 | Abigail Marie Brunner | Nurse Practitioner | 208 Township Blvd, Suite 100, Camillus, NY 13031 | 2019-08-08 |
| 1649779547 | Claire Isaacson | Counselor | 6000 W Genesee St Ste 400, Camillus, NY 13031 | 2018-02-06 |
| 1811426190 | At Home Independent Living, Inc. | In Home Supportive Care | 4464 Milton Ave, Syracuse, NY 13031 | 2017-06-08 |
| 1548643471 | Podiatry Services of Central New York, PC | Podiatrist | 4912 West Genesee Street, Camillus, NY 13031 | 2015-07-09 |
| 1023497203 | New York Anesthesiology Medical Specialties, PC | Pain Medicine | 5417 West Genesee Street, Suite 1, Camillus, NY 13031 | 2015-05-21 |
| 1194130377 | Costco Wholesale Corporation | Pharmacy | 120 Township Blvd, Camillus, NY 13031 | 2014-06-25 |
| 1487084976 | Todd Ray | Social Worker | 6000 W Genesee St, Camillus, NY 13031 | 2013-11-19 |
| 1093045155 | Rebecca Mae Goal Carroll | Physical Therapist | 5417 W Genesee St, Camillus, NY 13031 | 2010-01-12 |
| Find all providers in zip 13031 | ||||
| Taxonomy Code | 207Q00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. |
| Notes: Source: American Board of Family Medicine [1/1/2007: changed title; 7/1/2007: added definition, added source; 7/1/2017: modified definition] - Note: The American Osteopathic Board of Family Physicians certification includes extensive use of Osteopathic Manipulative Treatment (OMT), which integrates the biological, clinical, and behavioral sciences. - Additional Resources: American Board of Family Medicine, www.theabfm.org. American Osteopathic Board of Family Physicians, www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Physicians or the American Board of Family Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1659491421 | Fairmount Family Medicine Pllc | Family Medicine | 5006 West Genesee Street, Camillus, NY 13031-2326 | 2007-03-29 |
| 1003819053 | Thomas J Laclair | Family Medicine | 436 Hinsdale Rd, Camillus, NY 13031-1648 | 2005-05-23 |
| 1245761642 | Kristine Faulknham | Family Medicine | 436 Hinsdale Rd, Camillus, NY 13031-1648 | 2017-03-27 |
| 1679992135 | Matthew Procopio | Family Medicine | 436 Hinsdale Rd, Camillus, NY 13031-1648 | 2014-04-14 |
| 1568753978 | Ian Trevor Daly | Family Medicine | 5700 W Genesee St, Family Care Medical Group, Ste. 109n, Camillus, NY 13031-3200 | 2011-04-20 |
| 1194976894 | David Thomas Hope | Family Medicine | 5415 W Genesee St, Suite 301, Camillus, NY 13031-2157 | 2008-10-01 |
| 1528244555 | Alice Miller | Family Medicine | 436 Hinsdale Rd, Camillus, NY 13031-1648 | 2008-01-22 |
| 1982675278 | David Christopher Manfredi | Family Medicine | 5415 W Genesee St, Suite 301, Camillus, NY 13031-2162 | 2006-01-27 |
| 1962487918 | Vincent Nicholas Scialdone | Family Medicine | 5700 W Genesee St, Camillus, NY 13031-3200 | 2005-12-13 |
| 1932184397 | Kime J Ristoff | Family Medicine | 5700 W Genesee St, Camillus, NY 13031-3200 | 2005-12-08 |
| Find all providers in CAMILLUS | ||||
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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.