Provider Demographics
NPI:1073624698
Name:AMBROSE, JEBAMONI (MD)
Entity Type:Individual
Prefix:DR
First Name:JEBAMONI
Middle Name:
Last Name:AMBROSE
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 1:245 US HIGHWAY 206
Mailing Address - Street 2:
Mailing Address - City:HILLSBOROUGH
Mailing Address - State:NJ
Mailing Address - Zip Code:08844-4139
Mailing Address - Country:US
Mailing Address - Phone:908-874-4422
Mailing Address - Fax:908-874-8077
Practice Address - Street 1:245 US HIGHWAY 206
Practice Address - Street 2:
Practice Address - City:HILLSBOROUGH
Practice Address - State:NJ
Practice Address - Zip Code:08844-4139
Practice Address - Country:US
Practice Address - Phone:908-874-4422
Practice Address - Fax:908-874-8077
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2024-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25573207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
0011753OtherU.S.H.C.P.
NJ2731100Medicaid
411055MOtherCIGNA
NJ2731100Medicaid
411055MOtherCIGNA