Healthcare Provider Details

I. General information

NPI: 1205047461
Provider Name (Legal Business Name): STEVEN JOHN AMBRUSKO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2007
Last Update Date: 01/06/2021
Certification Date: 01/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ELM AT CARLTON STREETS
BUFFALO NY
14263-2006
US

IV. Provider business mailing address

1001 MAIN ST FL 5
BUFFALO NY
14203-1009
US

V. Phone/Fax

Practice location:
  • Phone: 716-845-4447
  • Fax: 716-845-3588
Mailing address:
  • Phone: 716-323-0000
  • Fax: 716-323-0290

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0207X
TaxonomyPediatric Hematology & Oncology Physician
License Number230423
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: