Healthcare Provider Details

I. General information

NPI: 1023475951
Provider Name (Legal Business Name): AXIOM LINK
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/22/2016
Last Update Date: 01/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14130 NOBLEWOOD PLZ SUITE 301
WOODBRIDGE VA
22193-1464
US

IV. Provider business mailing address

14130 NOBLEWOOD PLZ SUITE 301
WOODBRIDGE VA
22193-1464
US

V. Phone/Fax

Practice location:
  • Phone: 703-237-2219
  • Fax: 703-237-2729
Mailing address:
  • Phone: 703-237-2219
  • Fax: 703-237-2729

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State

VIII. Authorized Official

Name: JULIA MATUZA
Title or Position: CEO
Credential:
Phone: 718-762-7633