Individual
ALFONSO VAN UDEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
N.D.
Contact information
Practice address
9859 CORONA AVE, CORONA, NY 11368-2783
(347) 858-1768
Mailing address
60 LATOURETTE LN, STATEN ISLAND, NY 10314-6363
(347) 858-1768
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
ND100185 FEDERAL
NY
Other
Enumeration date
06/14/2013
Last updated
06/14/2013
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