MEDICARE: RENETTE AMBROISE R.N

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	595342	NY
2	101YM0800X	Mental Health Counselor	595342	NY

General Provider Information

NPI Number	:	1124471776
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RENETTE AMBROISE R.N

Provider Business Mailing Address
First Line	:	998 CROOKED HILL RD
Second Line	:
City	:	BRENTWOOD
State	:	NY
Zip	:	11717-1019
Country	:	US
Telephone Number	:	631-761-2177
Fax Number	:

Provider Business Practice Location Address
First Line	:	265 BROADHOLLOW RD STE 101
Second Line	:
City	:	MELVILLE
State	:	NY
Zip	:	11747-4833
Country	:	US
Telephone Number	:	914-216-7585
Fax Number	:	914-216-7585

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/19/2016
Last Update Date	:	04/02/2025

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