Healthcare Provider Details

I. General information

NPI: 1073549697
Provider Name (Legal Business Name): AMBIA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/24/2006
Last Update Date: 07/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1578 OLD YORK RD
ABINGTON PA
19001-1709
US

IV. Provider business mailing address

1578 OLD YORK RD
ABINGTON PA
19001-1709
US

V. Phone/Fax

Practice location:
  • Phone: 215-830-8460
  • Fax: 215-830-8464
Mailing address:
  • Phone: 215-830-8460
  • Fax: 215-830-8264

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number
License Number State

VIII. Authorized Official

Name: CHRISTINA BLADEN
Title or Position: OFFICE MANAGER
Credential:
Phone: 215-830-8460