Provider Demographics
NPI:1013257864
Name:AZUCAR, ALFONSO MANUEL (PHYSICIAN ASSISTANT)
Entity Type:Individual
Prefix:MR
First Name:ALFONSO
Middle Name:MANUEL
Last Name:AZUCAR
Suffix:
Gender:M
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 WATER STREET 2ND FLOOR CRED DEPT
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10041-0004
Mailing Address - Country:US
Mailing Address - Phone:646-680-2888
Mailing Address - Fax:516-542-5556
Practice Address - Street 1:260 W. SUNRISE HWY, STE. 200
Practice Address - Street 2:
Practice Address - City:VALLEY STREAM
Practice Address - State:NY
Practice Address - Zip Code:11581
Practice Address - Country:US
Practice Address - Phone:516-825-3600
Practice Address - Fax:516-872-5137
Is Sole Proprietor?:No
Enumeration Date:2013-02-14
Last Update Date:2019-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016408363A00000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant