Provider Demographics
NPI:1659503555
Name:AXELRAD, GARY N (MD)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:N
Last Name:AXELRAD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 TWIN LAKES DR
Mailing Address - Street 2:
Mailing Address - City:MANALAPAN
Mailing Address - State:NJ
Mailing Address - Zip Code:07726-8681
Mailing Address - Country:US
Mailing Address - Phone:732-431-5347
Mailing Address - Fax:732-431-8256
Practice Address - Street 1:9 TWIN LAKES DR
Practice Address - Street 2:
Practice Address - City:MANALAPAN
Practice Address - State:NJ
Practice Address - Zip Code:07726-8681
Practice Address - Country:US
Practice Address - Phone:732-431-5347
Practice Address - Fax:732-431-8256
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-12
Last Update Date:2009-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA03884800208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery