Healthcare Provider Details

I. General information

NPI: 1437322385
Provider Name (Legal Business Name): ANTHONY D'AMBROSIO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2008
Last Update Date: 02/23/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 ROUTE 52
CARMEL NY
10512-1200
US

IV. Provider business mailing address

32 GARDENIA LN
WALDEN NY
12586-2934
US

V. Phone/Fax

Practice location:
  • Phone: 845-228-2910
  • Fax: 845-228-2914
Mailing address:
  • Phone: 973-650-0865
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number257291
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: