Provider Demographics
NPI:1245592757
Name:AMBROSE, CYNTHIA
Entity Type:Individual
Prefix:MS
First Name:CYNTHIA
Middle Name:
Last Name:AMBROSE
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 1:411 MAIN ST
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:CATSKILL
Mailing Address - State:NY
Mailing Address - Zip Code:12414-1358
Mailing Address - Country:US
Mailing Address - Phone:518-719-3616
Mailing Address - Fax:
Practice Address - Street 1:411 MAIN ST
Practice Address - Street 2:3RD FLOOR
Practice Address - City:CATSKILL
Practice Address - State:NY
Practice Address - Zip Code:12414-1358
Practice Address - Country:US
Practice Address - Phone:518-719-3616
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-11
Last Update Date:2012-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00473230Medicaid