Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207KA0200X | Allergist | 25MB06781700 | NJ |
NPI | 1295765675 |
---|---|
Provider Name | Patrick M Ambrosio |
First Address | Tarrytown, NY 10591-5139 |
Second Address | Old Bridge, NJ 08857-3518 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/07/2006 |
Last Update Date | 01/04/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2214411000 | AMERIHEALTH (01) | NJ |
7949319 | AETNA (01) | NJ |
H37446 | (02) | NJ |