Provider Demographics
NPI:1396922969
Name:AXELROD, ROBERT ALLEN (MS/CCC/SP)
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:ALLEN
Last Name:AXELROD
Suffix:
Gender:M
Credentials:MS/CCC/SP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:79 RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:NEW CITY
Mailing Address - State:NY
Mailing Address - Zip Code:10956-6824
Mailing Address - Country:US
Mailing Address - Phone:845-323-4182
Mailing Address - Fax:845-638-6026
Practice Address - Street 1:79 RIDGE RD
Practice Address - Street 2:
Practice Address - City:NEW CITY
Practice Address - State:NY
Practice Address - Zip Code:10956-6824
Practice Address - Country:US
Practice Address - Phone:845-323-4182
Practice Address - Fax:845-638-6026
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-26
Last Update Date:2008-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002193-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist