Provider Demographics
NPI:1285736066
Name:AMBIS, STANLEY WALTER (MD)
Entity type:Individual
Prefix:
First Name:STANLEY
Middle Name:WALTER
Last Name:AMBIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 TOUNTAS AVE
Mailing Address - Street 2:SUITE 4
Mailing Address - City:LE ROY
Mailing Address - State:NY
Mailing Address - Zip Code:14482-1368
Mailing Address - Country:US
Mailing Address - Phone:585-768-6530
Mailing Address - Fax:585-768-4593
Practice Address - Street 1:3 TOUNTAS AVE
Practice Address - Street 2:SUITE 4
Practice Address - City:LE ROY
Practice Address - State:NY
Practice Address - Zip Code:14482-1368
Practice Address - Country:US
Practice Address - Phone:585-768-6530
Practice Address - Fax:585-768-4593
Is Sole Proprietor?:No
Enumeration Date:2006-09-02
Last Update Date:2016-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYA206094171100000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
103474BFOtherPREFERRED CARE
3391353OtherIHA
P010206094OtherBCBS OF ROCHESTER
103474GBOtherPREFERRED CARE ACUPUNCURE
00025084401OtherUNIVERA
5998829OtherGHI
5724679OtherAETNA
080144934OtherRAILROAD
CC1766OtherPIN
040426004274OtherFIDELIS
1826038OtherFIRST HEALTH
005259021OtherBCBS OF WNY
G36839OtherUPIN
080144934OtherRAILROAD
103474GBOtherPREFERRED CARE ACUPUNCURE