Provider Demographics
NPI:1881800282
Name:PAUL AXELRAD AND JACQUELINE ZUCKERBROD
Entity type:Organization
Organization Name:PAUL AXELRAD AND JACQUELINE ZUCKERBROD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:R
Authorized Official - Last Name:AXELRAD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-363-6222
Mailing Address - Street 1:4774 US HIGHWAY 9
Mailing Address - Street 2:
Mailing Address - City:HOWELL
Mailing Address - State:NJ
Mailing Address - Zip Code:07731-3354
Mailing Address - Country:US
Mailing Address - Phone:732-363-6222
Mailing Address - Fax:732-363-6222
Practice Address - Street 1:4774 US HIGHWAY 9
Practice Address - Street 2:
Practice Address - City:HOWELL
Practice Address - State:NJ
Practice Address - Zip Code:07731-3354
Practice Address - Country:US
Practice Address - Phone:732-363-6222
Practice Address - Fax:732-363-6222
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-15
Last Update Date:2011-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA05013600208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ720253Medicare ID - Type Unspecified