Basic Information
| Provider Information | |||||||||
| NPI: | 1285736066 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | AMBIS | ||||||||
| FirstName: | STANLEY | ||||||||
| MiddleName: | WALTER | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | |||||||||
| OtherFirstName: | |||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | |||||||||
| Mailing Information | |||||||||
| Address1: | 3 TOUNTAS AVE | ||||||||
| Address2: | SUITE 4 | ||||||||
| City: | LE ROY | ||||||||
| State: | NY | ||||||||
| PostalCode: | 144821368 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5857686530 | ||||||||
| FaxNumber: | 5857684593 | ||||||||
| Practice Location | |||||||||
| Address1: | 3 TOUNTAS AVE | ||||||||
| Address2: | SUITE 4 | ||||||||
| City: | LE ROY | ||||||||
| State: | NY | ||||||||
| PostalCode: | 144821368 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5857686530 | ||||||||
| FaxNumber: | 5857684593 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/02/2006 | ||||||||
| LastUpdateDate: | 01/21/2016 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | |||||||||
| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | M | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 171100000X | A206094 | NY | N | Other Service Providers | Acupuncturist | 207Q00000X | A206094 | NY | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 103474BF | 01 | PREFERRED CARE | OTHER | 3391353 | 01 | IHA | OTHER | P010206094 | 01 | BCBS OF ROCHESTER | OTHER | 103474GB | 01 | PREFERRED CARE ACUPUNCURE | OTHER | 00025084401 | 01 | UNIVERA | OTHER | 5998829 | 01 | GHI | OTHER | 5724679 | 01 | AETNA | OTHER | 080144934 | 01 | RAILROAD | OTHER | CC1766 | 01 | PIN | OTHER | 040426004274 | 01 | FIDELIS | OTHER | 1826038 | 01 | FIRST HEALTH | OTHER | 005259021 | 01 | BCBS OF WNY | OTHER | G36839 | 01 | UPIN | OTHER |