Provider Demographics
NPI:1811072531
Name:AXELROD, MORTON R (MD)
Entity type:Individual
Prefix:DR
First Name:MORTON
Middle Name:R
Last Name:AXELROD
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1727 AMSTERDAM AVE
Mailing Address - Street 2:4TH FLR.
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10031-4611
Mailing Address - Country:US
Mailing Address - Phone:212-862-0054
Mailing Address - Fax:212-926-0487
Practice Address - Street 1:1727 AMSTERDAM AVE
Practice Address - Street 2:4TH FLR.
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10031-4611
Practice Address - Country:US
Practice Address - Phone:212-862-0054
Practice Address - Fax:212-926-0487
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2025-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY088019207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00138770Medicaid
NYB15116Medicare UPIN