Healthcare Provider Details

I. General information

NPI: 1285736066
Provider Name (Legal Business Name): STANLEY WALTER AMBIS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/02/2006
Last Update Date: 01/21/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 TOUNTAS AVE SUITE 4
LE ROY NY
14482-1368
US

IV. Provider business mailing address

3 TOUNTAS AVE SUITE 4
LE ROY NY
14482-1368
US

V. Phone/Fax

Practice location:
  • Phone: 585-768-6530
  • Fax: 585-768-4593
Mailing address:
  • Phone: 585-768-6530
  • Fax: 585-768-4593

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberA206094
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA206094
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: