1770687212 NPI number — MORTON L AXELROD PHD

Table of content: MORTON L AXELROD PHD (NPI 1770687212)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770687212 NPI number — MORTON L AXELROD PHD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
AXELROD
Provider First Name:
MORTON
Provider Middle Name:
L
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PHD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1770687212
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/24/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
366 VALLEY VIEW RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KING OF PRUSSIA
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19406-3132
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-290-0989
Provider Business Mailing Address Fax Number:
610-265-1797

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
366 VALLEY VIEW RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KING OF PRUSSIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19406-3132
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
800-290-0989
Provider Business Practice Location Address Fax Number:
610-265-1797
Provider Enumeration Date:
09/12/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  PC001541 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 102L00000X , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 106H00000X , with the licence number: PC001541 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YP2500X , with the licence number: PC001541 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 000374984 . This is a "UNITED BEHAVIORAL HEALTH - UBH" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 11654143 . This is a "CAQH" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 7196480 . This is a "AETNA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".