Provider Demographics
NPI:1275826000
Name:WAYNE AXMAN
Entity Type:Organization
Organization Name:WAYNE AXMAN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WAYEN
Authorized Official - Middle Name:R
Authorized Official - Last Name:AXMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:718-626-3800
Mailing Address - Street 1:PO BOX 27
Mailing Address - Street 2:
Mailing Address - City:ATLANTIC BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11509-0027
Mailing Address - Country:US
Mailing Address - Phone:718-626-3800
Mailing Address - Fax:718-721-6553
Practice Address - Street 1:3016 30TH DR FL 3
Practice Address - Street 2:
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11102-1874
Practice Address - Country:US
Practice Address - Phone:718-626-3800
Practice Address - Fax:718-721-6553
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-26
Last Update Date:2011-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY4662140001Medicare NSC