Basic Information
| Provider Information | |||||||||
| NPI: | 1457606691 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | D'AMBROSO | ||||||||
| FirstName: | STEVEN | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 266 | ||||||||
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| City: | GOSHEN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 109240266 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8456151585 | ||||||||
| FaxNumber: | 8456151576 | ||||||||
| Practice Location | |||||||||
| Address1: | 530 MAIN ST | ||||||||
| Address2: | |||||||||
| City: | ARMONK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 105041843 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9172739100 | ||||||||
| FaxNumber: | 9142739101 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/13/2012 | ||||||||
| LastUpdateDate: | 07/13/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 035244 | NY | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.