MEDICARE: AXIOMWELLNESS LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332BC3200X	Customized Equipment (DME)	38MC00613700	NJ

General Provider Information

NPI Number	:	1538308762
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AXIOMWELLNESS LLC

Provider Business Mailing Address
First Line	:	2357 LEMOINE AVE
Second Line	:
City	:	FORT LEE
State	:	NJ
Zip	:	07024-6229
Country	:	US
Telephone Number	:	201-944-4552
Fax Number	:	201-944-6551

Provider Business Practice Location Address
First Line	:	2357 LEMOINE AVE
Second Line	:
City	:	FORT LEE
State	:	NJ
Zip	:	07024
Country	:	US
Telephone Number	:	201-944-4552
Fax Number	:	201-944-6551

Authorized Official
Title or Position	:	OWNER
Name	:	JOHN KIM
Credential	:
Telephone Number	:	201-944-4552

Provider Enumeration Date	:	02/11/2009
Last Update Date	:	02/11/2009

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