Provider Demographics
NPI:1326302639
Name:AXIOM HOLISTIC, LLC
Entity Type:Organization
Organization Name:AXIOM HOLISTIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:FOSTER
Authorized Official - Last Name:COHEN
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:646-633-4606
Mailing Address - Street 1:245 E 19TH ST APT 19B
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10003-2663
Mailing Address - Country:US
Mailing Address - Phone:646-633-4606
Mailing Address - Fax:646-349-1764
Practice Address - Street 1:49 W 24TH ST
Practice Address - Street 2:8TH FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10010-3206
Practice Address - Country:US
Practice Address - Phone:646-633-4606
Practice Address - Fax:646-349-1764
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-02
Last Update Date:2012-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY25 003835171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty