MEDICARE: HERMAN A AMBRIS M.D.

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	208100000X	Physical Medicine & Rehabilitation Physician	173632	NY

General Provider Information

NPI Number	:	1407942824
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HERMAN A AMBRIS M.D.

Provider Business Mailing Address
First Line	:	480 MONTAUK AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11208-4825
Country	:	US
Telephone Number	:	718-927-0615
Fax Number	:	718-927-1372

Provider Business Practice Location Address
First Line	:	583 PENNSYLVANIA AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11207-6307
Country	:	US
Telephone Number	:	718-257-7000
Fax Number	:	718-257-7454

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

Provider Enumeration Date	:	10/04/2006
Last Update Date	:	04/21/2008

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