Provider Demographics
NPI:1568699585
Name:DYSAUTONOMIA CENTER LLP
Entity Type:Organization
Organization Name:DYSAUTONOMIA CENTER LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:FELICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:AXELROD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:212-263-7225
Mailing Address - Street 1:530 1ST AVE
Mailing Address - Street 2:SUITE 9Q
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-6402
Mailing Address - Country:US
Mailing Address - Phone:212-263-7225
Mailing Address - Fax:212-263-7041
Practice Address - Street 1:530 1ST AVE
Practice Address - Street 2:SUITE 9Q
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-6402
Practice Address - Country:US
Practice Address - Phone:212-263-7225
Practice Address - Fax:212-263-7041
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-17
Last Update Date:2009-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY099123208000000X
NY1681662084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty