Provider Demographics
NPI:1043585227
Name:AXELRAD, JORDAN ERIC (MD, MPH)
Entity Type:Individual
Prefix:DR
First Name:JORDAN
Middle Name:ERIC
Last Name:AXELRAD
Suffix:
Gender:M
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:240 E 38TH ST FL 23
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-2708
Mailing Address - Country:US
Mailing Address - Phone:212-263-3095
Mailing Address - Fax:212-263-3096
Practice Address - Street 1:240 E 38TH ST FL 23
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016
Practice Address - Country:US
Practice Address - Phone:212-263-3095
Practice Address - Fax:212-263-3096
Is Sole Proprietor?:No
Enumeration Date:2012-03-20
Last Update Date:2021-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY271009207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology