| Axiom Medical Pc | |
|
9602 Avenue L Brooklyn NY 11236-4813 | |
| (718) 444-0437 | |
| (718) 763-1267 |
| Full Name | Axiom Medical Pc |
|---|---|
| Speciality | General Practice |
| Location | 9602 Avenue L, Brooklyn, New York |
| Authorized Official Name and Position | Daniel Dume-charles (OWNER) |
| Authorized Official Contact | 7184440437 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Axiom Medical Pc 842 Van Buren St Baldwin NY 11510-4652 Ph: (718) 444-0437 | Axiom Medical Pc 9602 Avenue L Brooklyn NY 11236-4813 Ph: (718) 444-0437 |
| NPI Number | 1689013443 |
|---|---|
| Provider Enumeration Date | 06/14/2013 |
| Last Update Date | 09/19/2022 |
| Medicare PECOS PAC ID | 1850534777 |
|---|---|
| Medicare Enrollment ID | O20130826000137 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1689013443 | NPI | - | NPPES |
| 03629696 | Medicaid | NY | |
| 220943 | Other | NY | NY LICENSE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208D00000X | General Practice | 220943 (New York) | Primary |
| Provider Name | Ernst Ducena |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1952334625 PECOS PAC ID: 8527042522 Enrollment ID: I20040616001383 |
| Provider Name | Daniel Dume-charles |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1578588182 PECOS PAC ID: 8224001904 Enrollment ID: I20040819000848 |
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