Provider Demographics
NPI:1457606691
Name:D'AMBROSO, STEVEN
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:
Last Name:D'AMBROSO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 266
Mailing Address - Street 2:
Mailing Address - City:GOSHEN
Mailing Address - State:NY
Mailing Address - Zip Code:10924-0266
Mailing Address - Country:US
Mailing Address - Phone:845-615-1585
Mailing Address - Fax:845-615-1576
Practice Address - Street 1:530 MAIN ST
Practice Address - Street 2:
Practice Address - City:ARMONK
Practice Address - State:NY
Practice Address - Zip Code:10504-1843
Practice Address - Country:US
Practice Address - Phone:917-273-9100
Practice Address - Fax:914-273-9101
Is Sole Proprietor?:No
Enumeration Date:2012-07-13
Last Update Date:2012-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY035244225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist