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General NPI Number Information
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NPI Number | 1174144661
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Entity Type | Individual
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Provider Name | MICHAEL AMBROSE PHD
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Gender | Male
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Dates
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Enumeration Date | 05/06/2020
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Last Update Date | 08/10/2023
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Provider Practice Location Address
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Address Line | 1 PARK AVE FL 7
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City | NEW YORK
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State | NY
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Zip | 10016-5818
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Country | US
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Telephone | 646-754-5052
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Fax |
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Provider Business Mailing Address
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Address Line | 453 FDR DR APT C504
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City | NEW YORK
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State | NY
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Zip | 10002-5904
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Country | US
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Telephone | 347-470-8787
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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