Provider Demographics
NPI:1255374062
Name:MAURO, ALFRED L (MD)
Entity type:Individual
Prefix:
First Name:ALFRED
Middle Name:L
Last Name:MAURO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 135
Mailing Address - Street 2:
Mailing Address - City:ORADELL
Mailing Address - State:NJ
Mailing Address - Zip Code:07649
Mailing Address - Country:US
Mailing Address - Phone:201-342-1205
Mailing Address - Fax:201-342-1259
Practice Address - Street 1:590 NEWARK AVE
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07306
Practice Address - Country:US
Practice Address - Phone:201-222-1400
Practice Address - Fax:201-342-1259
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-13
Last Update Date:2012-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA02182900174400000X, 208VP0000X, 207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
No174400000XOther Service ProvidersSpecialist
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0965308Medicaid
NJC59927Medicare UPIN