Provider Demographics
NPI:1083246995
Name:D'AMBROSE, DIANA NICOLE (R-DMT, LCAT, MS DMT)
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:NICOLE
Last Name:D'AMBROSE
Suffix:
Gender:F
Credentials:R-DMT, LCAT, MS DMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1850 E 34TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11234-4430
Mailing Address - Country:US
Mailing Address - Phone:917-589-2141
Mailing Address - Fax:
Practice Address - Street 1:156 5TH AVE STE 1223
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10010-7735
Practice Address - Country:US
Practice Address - Phone:646-661-0259
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-08
Last Update Date:2020-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225600000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDance Therapist