MEDICARE: MR. ALFREDO D MADURO SR. RPAC

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	363AM0700X	Medical Physician Assistant	009800	NY

General Provider Information

NPI Number	:	1932395068
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ALFREDO D MADURO SR. RPAC

Provider Business Mailing Address
First Line	:	4039 JUNCTION BLVD
Second Line	:
City	:	CORONA
State	:	NY
Zip	:	11368-2121
Country	:	US
Telephone Number	:	718-397-8866
Fax Number	:	718-397-8869

Provider Business Practice Location Address
First Line	:	4039 JUNCTION BLVD
Second Line	:
City	:	CORONA
State	:	NY
Zip	:	11368-2121
Country	:	US
Telephone Number	:	718-397-8866
Fax Number	:	718-397-8869

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/21/2007
Last Update Date	:	09/21/2007

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