MEDICARE: JEBAMONI AMBROSE M.D.P.A.

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	207R00000X	Internal Medicine Physician	25573	NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1962727867
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JEBAMONI AMBROSE M.D.P.A.

Provider Business Mailing Address
First Line	:	245 ROUTE 206
Second Line	:
City	:	HILLSBOROUGH
State	:	NJ
Zip	:	08844-4139
Country	:	US
Telephone Number	:	908-874-4422
Fax Number	:	908-874-8077

Provider Business Practice Location Address
First Line	:	245 ROUTE 206
Second Line	:
City	:	HILLSBOROUGH
State	:	NJ
Zip	:	08844-4139
Country	:	US
Telephone Number	:	908-874-4422
Fax Number	:	908-874-8077

Authorized Official
Title or Position	:	PRESIDENT
Name	:	JEBAMONI AMBROSE
Credential	:	M.D.
Telephone Number	:	908-874-4422

Provider Enumeration Date	:	04/02/2010
Last Update Date	:	04/02/2010

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