Provider Demographics
NPI:1518103688
Name:AXON NEUROSURGICAL PLLC
Entity Type:Organization
Organization Name:AXON NEUROSURGICAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:ERICO
Authorized Official - Middle Name:RAMOS
Authorized Official - Last Name:CARDOSO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-963-7266
Mailing Address - Street 1:249 DEGRAW ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11231-4440
Mailing Address - Country:US
Mailing Address - Phone:718-963-7266
Mailing Address - Fax:718-963-6491
Practice Address - Street 1:374 STOCKHOLM ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11237-4006
Practice Address - Country:US
Practice Address - Phone:718-963-7266
Practice Address - Fax:718-963-6491
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-19
Last Update Date:2008-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY188413207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty