Healthcare Provider Details

I. General information

NPI: 1578467932
Provider Name (Legal Business Name): AXIS GASTROENTEROLOGY P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/07/2026
Last Update Date: 10/07/2026
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1939 MARLTON PIKE E STE 250
CHERRY HILL NJ
08003-4507
US

IV. Provider business mailing address

1939 MARLTON PIKE E STE 250
CHERRY HILL NJ
08003-4507
US

V. Phone/Fax

Practice location:
  • Phone: 856-429-4433
  • Fax:
Mailing address:
  • Phone: 856-429-4433
  • Fax: 856-444-5406

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: RANDA FODA
Title or Position: BUSINESS MANAGER
Credential:
Phone: 609-332-4731