Provider Demographics
NPI:1275520801
Name:AXELROD, FREDERICK WAYNE (MD)
Entity Type:Individual
Prefix:DR
First Name:FREDERICK
Middle Name:WAYNE
Last Name:AXELROD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:185 E 85TH ST
Mailing Address - Street 2:APT # 5K
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10028-2140
Mailing Address - Country:US
Mailing Address - Phone:203-863-3363
Mailing Address - Fax:203-863-4739
Practice Address - Street 1:185 E 85TH ST
Practice Address - Street 2:APT # 5K
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10028-2140
Practice Address - Country:US
Practice Address - Phone:203-863-3363
Practice Address - Fax:203-863-4739
Is Sole Proprietor?:No
Enumeration Date:2005-09-29
Last Update Date:2010-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT038076207L00000X
NY192793-1207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01620093-4Medicaid
NY01620093-4Medicaid
01797AMedicare ID - Type Unspecified