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General NPI Number Information
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NPI Number | 1578467932
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Entity Type | Organization
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Legal Business Name | AXIS GASTROENTEROLOGY P.A.
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Dates
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Enumeration Date | 10/07/2026
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Last Update Date | 10/07/2026
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Provider Practice Location Address
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Address Line | 1939 MARLTON PIKE E STE 250
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City | CHERRY HILL
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State | NJ
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Zip | 08003-4507
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Country | US
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Telephone | 856-429-4433
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Fax |
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Provider Business Mailing Address
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Address Line | 1939 MARLTON PIKE E STE 250
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City | CHERRY HILL
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State | NJ
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Zip | 08003-4507
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Country | US
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Telephone | 856-429-4433
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Fax | 856-444-5406
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Authorized Official
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Title or Position | BUSINESS MANAGER
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Name | RANDA FODA
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Credential |
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Telephone | 609-332-4731
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207K00000X
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Taxonomy Name | Allergy & Immunology Physician
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License Number |
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License Number State | NULL
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Taxonomy #2
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number |
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License Number State | NULL
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