Provider Demographics
NPI:1124069216
Name:AXEN, RAFAEL Z (MD)
Entity type:Individual
Prefix:
First Name:RAFAEL
Middle Name:Z
Last Name:AXEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 SOUTH BEDFORD ROAD
Mailing Address - Street 2:
Mailing Address - City:MOUNT KISCO
Mailing Address - State:NY
Mailing Address - Zip Code:10549-3412
Mailing Address - Country:US
Mailing Address - Phone:914-244-6789
Mailing Address - Fax:914-242-1516
Practice Address - Street 1:34 SOUTH BEDFORD ROAD
Practice Address - Street 2:
Practice Address - City:MT. KISCO
Practice Address - State:NY
Practice Address - Zip Code:10549
Practice Address - Country:US
Practice Address - Phone:914-244-6789
Practice Address - Fax:914-242-1516
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2016-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY227630207L00000X, 207LP3000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207LP3000XAllopathic & Osteopathic PhysiciansAnesthesiologyPediatric Anesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY227630OtherLICENSE
NYDB5589OtherGROUP MEDICARE RAILROAD
NY1725T1Medicare PIN
NYWLM261Medicare PIN
NY1725TLM261Medicare PIN