Healthcare Provider Details

I. General information

NPI: 1659221331
Provider Name (Legal Business Name): AXIS PROJECT INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/02/2026
Last Update Date: 02/03/2026
Certification Date: 02/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

118 E 108TH ST
NEW YORK NY
10029-3501
US

IV. Provider business mailing address

64 E 111TH ST APT 907
NEW YORK NY
10029-2688
US

V. Phone/Fax

Practice location:
  • Phone: 347-645-3265
  • Fax: 888-391-5799
Mailing address:
  • Phone: 347-645-3265
  • Fax: 888-391-5799

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License Number
License Number StateNULL
# 5
Primary TaxonomyN
Taxonomy Code174200000X
TaxonomyMeals Provider
License Number
License Number StateNULL
# 6
Primary TaxonomyN
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number StateNULL

VIII. Authorized Official

Name: GEORGE GALLEGO
Title or Position: CEO
Credential: MSOL
Phone: 347-645-3265