Healthcare Provider Details

I. General information

NPI: 1770549115
Provider Name (Legal Business Name): ROY M AMBINDER M. D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2006
Last Update Date: 08/03/2022
Certification Date: 08/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

106 BOSTON AVE STE 105
ALTAMONTE SPRINGS FL
32701-4711
US

IV. Provider business mailing address

PO BOX 102222 ATTN: CREDENTIAL DEPARTMENT
ATLANTA GA
30368-2222
US

V. Phone/Fax

Practice location:
  • Phone: 407-553-7710
  • Fax: 866-445-1446
Mailing address:
  • Phone: 239-274-8200
  • Fax: 239-278-3350

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZH0000X
TaxonomyHematology (Pathology) Physician
License NumberME35288
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License NumberME35288
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: