Provider Demographics
NPI:1073882122
Name:AMBAY HEALTH NETWORK
Entity type:Organization
Organization Name:AMBAY HEALTH NETWORK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:RICK
Authorized Official - Middle Name:
Authorized Official - Last Name:AHUJA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:773-837-1550
Mailing Address - Street 1:2390 DORINA DR
Mailing Address - Street 2:
Mailing Address - City:NORTHFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60093-2706
Mailing Address - Country:US
Mailing Address - Phone:773-837-1550
Mailing Address - Fax:847-441-8581
Practice Address - Street 1:2390 DORINA DR
Practice Address - Street 2:
Practice Address - City:NORTHFIELD
Practice Address - State:IL
Practice Address - Zip Code:60093-2706
Practice Address - Country:US
Practice Address - Phone:773-837-1550
Practice Address - Fax:847-441-8581
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-19
Last Update Date:2011-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service