Provider Demographics
NPI:1659816627
Name:DOCAXT, INC
Entity Type:Organization
Organization Name:DOCAXT, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALFREDO
Authorized Official - Middle Name:L
Authorized Official - Last Name:AXTMAYER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:203-265-9122
Mailing Address - Street 1:85 BARNES RD
Mailing Address - Street 2:SUITE 301
Mailing Address - City:WALLINGFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06492-1832
Mailing Address - Country:US
Mailing Address - Phone:203-265-9122
Mailing Address - Fax:203-265-9159
Practice Address - Street 1:85 BARNES RD
Practice Address - Street 2:SUITE 301
Practice Address - City:WALLINGFORD
Practice Address - State:CT
Practice Address - Zip Code:06492-1832
Practice Address - Country:US
Practice Address - Phone:203-265-9122
Practice Address - Fax:203-265-9159
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-30
Last Update Date:2016-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT022215207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty