Provider Demographics
NPI:1346218880
Name:AMBROSE, ANNE FELICIA (MD)
Entity type:Individual
Prefix:DR
First Name:ANNE
Middle Name:FELICIA
Last Name:AMBROSE
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:10 BELL CIRCLE ROAD
Mailing Address - Street 2:
Mailing Address - City:PORT JEFFERSON
Mailing Address - State:NY
Mailing Address - Zip Code:11777
Mailing Address - Country:US
Mailing Address - Phone:631-444-8118
Mailing Address - Fax:631-392-7213
Practice Address - Street 1:NEUROLOGY ASSOCIATES OF STONY BROOK
Practice Address - Street 2:4 SMITH HAVEN MALL SUITE 105
Practice Address - City:LAKE GROVE
Practice Address - State:NY
Practice Address - Zip Code:11755-2412
Practice Address - Country:US
Practice Address - Phone:631-444-2599
Practice Address - Fax:631-392-7213
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-10
Last Update Date:2024-12-18
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY2352432081P0301X, 208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No2081P0301XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationBrain Injury Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02588223Medicaid
NY0615J1Medicare ID - Type Unspecified
NY02588223Medicaid