Provider Demographics
NPI:1659083897
Name:FROMETA, AXXEL ALEXIS
Entity Type:Individual
Prefix:
First Name:AXXEL
Middle Name:ALEXIS
Last Name:FROMETA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5552 NETHERLAND AVE APT C
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10471-2352
Mailing Address - Country:US
Mailing Address - Phone:347-360-3913
Mailing Address - Fax:
Practice Address - Street 1:1230 MAMARONECK AVE STE 100
Practice Address - Street 2:
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10605-5231
Practice Address - Country:US
Practice Address - Phone:518-675-3564
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-20
Last Update Date:2024-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF432444-01363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care