Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | 159842 | NY |
N | 208600000X | Surgeon | 159842 | NY |
N | 208200000X | Surgeon | 25MA07744200 | NJ |
N | 208600000X | Surgeon | 25MA07744200 | NJ |
Y | 208G00000X | Cardiothoracic Vascular Surgeon | 25MA07744200 | NJ |
NPI | 1093705014 |
---|---|
Provider Name | Howard Ian Axelrod |
First Address | Pomona, NJ 08240-9102 |
Second Address | Pomona, NJ 08240-9102 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/10/2005 |
Last Update Date | 17/02/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0044440 | (05) | NJ |
E51325 | (02) | |
E51325 | (02) | NY |