MEDICARE: DR. ANTHONY LOUIS D'AMBROSIO M.D.

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	207T00000X	Neurological Surgery Physician	220564	NY
2	207T00000X	Neurological Surgery Physician	25MA08233900	NJ

General Provider Information

NPI Number	:	1356463079
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANTHONY LOUIS D'AMBROSIO M.D.

Provider Business Mailing Address
First Line	:	1200 E RIDGEWOOD AVE STE 200
Second Line	:
City	:	RIDGEWOOD
State	:	NJ
Zip	:	07450-3937
Country	:	US
Telephone Number	:	201-327-8600
Fax Number	:	201-327-8225

Provider Business Practice Location Address
First Line	:	1200 E RIDGEWOOD AVE STE 200
Second Line	:
City	:	RIDGEWOOD
State	:	NJ
Zip	:	07450-3937
Country	:	US
Telephone Number	:	201-327-8600
Fax Number	:	201-327-8225

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

Provider Enumeration Date	:	04/04/2007
Last Update Date	:	09/04/2025

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