Healthcare Provider Details

I. General information

NPI: 1528687209
Provider Name (Legal Business Name): AMBAR R BUX DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2020
Last Update Date: 12/05/2024
Certification Date: 12/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

475 SEAVIEW AVE
STATEN ISLAND NY
10305-3436
US

IV. Provider business mailing address

PO BOX 669379
DALLAS TX
75266-9379
US

V. Phone/Fax

Practice location:
  • Phone: 718-226-8855
  • Fax:
Mailing address:
  • Phone: 985-898-4451
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number341093
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: