Individual
ERICA LYNN AXELROD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
5 POND DR, SYOSSET, NY 11791-2207
(516) 935-3828
Mailing address
5 POND DR, SYOSSET, NY 11791-2207
(516) 935-3828
Taxonomy
Speciality
Code
Description
License number
State
252Y00000X
Early Intervention Provider Agency
114093021
NY
252Y00000X
Early Intervention Provider Agency
Primary
696020961
NY
252Y00000X
Early Intervention Provider Agency
696021961
NY
Other
Enumeration date
09/22/2012
Last updated
09/22/2012
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