Basic Information
| Provider Information | |||||||||
| NPI: | 1255374062 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MAURO | ||||||||
| FirstName: | ALFRED | ||||||||
| MiddleName: | L | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 135 | ||||||||
| Address2: | |||||||||
| City: | ORADELL | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 07649 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2013421205 | ||||||||
| FaxNumber: | 2013421259 | ||||||||
| Practice Location | |||||||||
| Address1: | 590 NEWARK AVE | ||||||||
| Address2: | |||||||||
| City: | JERSEY CITY | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 07306 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2012221400 | ||||||||
| FaxNumber: | 2013421259 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/13/2006 | ||||||||
| LastUpdateDate: | 11/26/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | 25MA02182900 | NJ | N | Other Service Providers | Specialist | 208VP0000X | 25MA02182900 | NJ | Y | Allopathic & Osteopathic Physicians | Pain Medicine | Pain Medicine | 207L00000X | 25MA02182900 | NJ | N | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | 0965308 | 05 | NJ | MEDICAID |