Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0207X | Pediatric Hematology-Oncologist | 230423 | NY |
NPI | 1205047461 |
---|---|
Provider Name | Dr. Steven John Ambrusko |
First Address | Buffalo, NY 14203-1009 |
Second Address | Buffalo, NY 14263-2006 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/05/2007 |
Last Update Date | 06/01/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00028091301 | UNIVERA (01) | |
000529373001 | BC/BS (01) | |
000529373002 | BC/BS (01) | |
02903271 | (05) | NY |
070905000009 | FIDELIS (01) | |
1214321 | IHA (01) |