Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0300X | Periodontist | 059115 | NY |
NPI | 1073929261 |
---|---|
Provider Name | Dr. Filip Ambrosio |
First Address | Rochester, NY 14624-1366 |
Second Address | Rochester, NY 14624-1366 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/07/2014 |
Last Update Date | 03/08/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
059115 | DENTAL LICENSE NUMBER (01) | NY |