MEDICARE: ANTHONY D'AMBROSIO 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	207Q00000X	Family Medicine Physician	257291	NY

General Provider Information

NPI Number	:	1437322385
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANTHONY D'AMBROSIO M.D.

Provider Business Mailing Address
First Line	:	32 GARDENIA LN
Second Line	:
City	:	WALDEN
State	:	NY
Zip	:	12586-2934
Country	:	US
Telephone Number	:	973-650-0865
Fax Number	:

Provider Business Practice Location Address
First Line	:	150 ROUTE 52
Second Line	:
City	:	CARMEL
State	:	NY
Zip	:	10512-1200
Country	:	US
Telephone Number	:	845-228-2910
Fax Number	:	845-228-2914

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

Provider Enumeration Date	:	04/10/2008
Last Update Date	:	02/23/2011

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