Provider Demographics
NPI:1023181252
Name:D'AMBROSIO, GABRIELLA L
Entity Type:Individual
Prefix:MRS
First Name:GABRIELLA
Middle Name:L
Last Name:D'AMBROSIO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:911 SUNSET RD
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08016-2250
Mailing Address - Country:US
Mailing Address - Phone:609-387-8787
Mailing Address - Fax:609-386-8640
Practice Address - Street 1:911 SUNSET RD
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:NJ
Practice Address - Zip Code:08016-2250
Practice Address - Country:US
Practice Address - Phone:609-387-8787
Practice Address - Fax:609-386-8640
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MP00059000363AM0700X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Not Answered208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice