Basic Information
| Provider Information | |||||||||
| NPI: | 1558509828 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | D'AMBROSIA | ||||||||
| FirstName: | DENISE | ||||||||
| MiddleName: | F.O. | ||||||||
| NamePrefix: | PROF. | ||||||||
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| Credential: | RN, FNP-C, PROF | ||||||||
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| Mailing Information | |||||||||
| Address1: | 47A SALLY LA | ||||||||
| Address2: | |||||||||
| City: | RIDGE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 119612429 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6313455198 | ||||||||
| FaxNumber: | 6313455198 | ||||||||
| Practice Location | |||||||||
| Address1: | T16-020 HSC | ||||||||
| Address2: | |||||||||
| City: | STONY BROOK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 117948171 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6314441062 | ||||||||
| FaxNumber: | 6314441054 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/26/2009 | ||||||||
| LastUpdateDate: | 01/26/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | F332998-1 | NY | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.