Provider Demographics
NPI:1932484508
Name:AXIOM PT & OT PLUS PLLC
Entity Type:Organization
Organization Name:AXIOM PT & OT PLUS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:ALBEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:914-961-1010
Mailing Address - Street 1:115 MAIN ST
Mailing Address - Street 2:SUITE: # 202
Mailing Address - City:TUCKAHOE
Mailing Address - State:NY
Mailing Address - Zip Code:10707-2911
Mailing Address - Country:US
Mailing Address - Phone:914-961-1010
Mailing Address - Fax:914-961-1011
Practice Address - Street 1:115 MAIN ST
Practice Address - Street 2:SUITE: # 202
Practice Address - City:TUCKAHOE
Practice Address - State:NY
Practice Address - Zip Code:10707-2911
Practice Address - Country:US
Practice Address - Phone:914-961-1010
Practice Address - Fax:914-961-1011
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-14
Last Update Date:2011-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY222Z00000X, 224L00000X, 224P00000X, 225000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotistGroup - Multi-Specialty
No224L00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPedorthistGroup - Multi-Specialty
No224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetistGroup - Multi-Specialty
No225000000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotic FitterGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03282455Medicaid