Keith Ryan Jackson MD PC

Public-record details

Address

11 Ralph Pl, Suite 209, Staten Island, NY 10304

Phone

(718) 727-1331

Listed under

Practices and organizations

NPI

1326216847

NPI status

Active in the NPPES registry

Provider type

Organization (practice, clinic or company)

Registered specialty (self-reported taxonomy)

Dermatology (207N00000X)

License number on NPI record

212165 (NY)

Authorized official

Keith Jackson, MD, President

NPI first issued

Feb 19, 2008

Years since NPI first issued

18 years (since 2008)

License state on NPI record

NY

NPI record last updated

May 29, 2013

Other dermatology listings at this street address

1

NPI 1326216847 is active in the federal NPPES registry (CMS) with Dermatology as its self-reported primary taxonomy; license 212165 (NY) is listed on the record. Source: NPPES NPI Registry (CMS) (record). Data as of 2026-10-16.

Public record, not an endorsement. This listing was compiled from public records as of 2026-10-16 and may be incomplete or out of date. Dermatologist Index does not vet, employ, recommend or guarantee dermatology practices; a badge reflects only what the public record showed on that date. Confirm current details with the official record before you decide. The information on Dermatologist Index is not medical advice and does not replace a doctor, nurse, discharge planner or other qualified professional. Do not use it to make decisions about diagnosis or treatment. If you have a medical emergency, call 911. Full disclaimer · Report an error

What these registry facts mean

The NPI (National Provider Identifier) is the federal ID every HIPAA-covered provider uses to bill insurance. This NPI belongs to an organization, so it may cover several clinicians at this location. The specialty is the taxonomy the provider chose when registering; NPPES does not check it. A license number here is what the provider entered — confirm it with the state board before you rely on it. A registered specialty is not board certification. To check board certification, use the American Board of Dermatology's verification tool (or the American Osteopathic Board of Dermatology for DOs), and confirm the medical license with the state board.

View NPI 1326216847 in the official registry ↗

Dermatology clinicians and practices at this address

Other listings in this directory whose NPI record gives the same street address and ZIP. A shared address usually means a shared practice or building; it does not by itself show who works with whom.

• Keith Jackson, MD