Individual
AXEN THEODORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
3325 BERTHA DR, BALDWIN, NY 11510-5006
(347) 821-2582
Mailing address
3325 BERTHA DR, BALDWIN, NY 11510-5006
(347) 821-2582
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
309721
NY
Other
Enumeration date
07/22/2015
Last updated
07/22/2015
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