Provider Demographics
NPI:1285653097
Name:D' AMBOLA, LESLY A (DO)
Entity type:Individual
Prefix:DR
First Name:LESLY
Middle Name:A
Last Name:D' AMBOLA
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5105 N PARK DR APT 1005
Mailing Address - Street 2:
Mailing Address - City:PENNSAUKEN
Mailing Address - State:NJ
Mailing Address - Zip Code:08109-4630
Mailing Address - Country:US
Mailing Address - Phone:856-986-6042
Mailing Address - Fax:
Practice Address - Street 1:42 E LAUREL RD STE 1800
Practice Address - Street 2:
Practice Address - City:STRATFORD
Practice Address - State:NJ
Practice Address - Zip Code:08084-1338
Practice Address - Country:US
Practice Address - Phone:856-566-6843
Practice Address - Fax:856-566-2775
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2024-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB08472900207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1Q0140OtherMEDICARE PIN
NJ7718209Medicaid
NJP00237616OtherRAILROAD MEDICARE
NJMB064729OtherMEDICAL LICENSE
NJP00237616OtherRAILROAD MEDICARE