Provider Demographics
NPI:1932395068
Name:MADURO, ALFREDO D SR (RPAC)
Entity Type:Individual
Prefix:MR
First Name:ALFREDO
Middle Name:D
Last Name:MADURO
Suffix:SR
Gender:M
Credentials:RPAC
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Mailing Address - Street 1:4039 JUNCTION BLVD
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:NY
Mailing Address - Zip Code:11368-2121
Mailing Address - Country:US
Mailing Address - Phone:718-397-8866
Mailing Address - Fax:718-397-8869
Practice Address - Street 1:4039 JUNCTION BLVD
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:NY
Practice Address - Zip Code:11368-2121
Practice Address - Country:US
Practice Address - Phone:718-397-8866
Practice Address - Fax:718-397-8869
Is Sole Proprietor?:No
Enumeration Date:2007-09-21
Last Update Date:2007-09-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY009800363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical