Provider Demographics
NPI:1346868940
Name:ALFRED, JUDE (NP)
Entity Type:Individual
Prefix:MR
First Name:JUDE
Middle Name:
Last Name:ALFRED
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:83 GRUSZ RD
Mailing Address - Street 2:
Mailing Address - City:WESTTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:10998-3900
Mailing Address - Country:US
Mailing Address - Phone:917-623-6783
Mailing Address - Fax:
Practice Address - Street 1:83 GRUSZ RD
Practice Address - Street 2:
Practice Address - City:WESTTOWN
Practice Address - State:NY
Practice Address - Zip Code:10998-3900
Practice Address - Country:US
Practice Address - Phone:917-623-6783
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-09
Last Update Date:2020-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF345702-01363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily