Provider Demographics
NPI:1407942824
Name:AMBRIS, HERMAN A (MD)
Entity Type:Individual
Prefix:
First Name:HERMAN
Middle Name:A
Last Name:AMBRIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:480 MONTAUK AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11208-4825
Mailing Address - Country:US
Mailing Address - Phone:718-927-0615
Mailing Address - Fax:718-927-1372
Practice Address - Street 1:583 PENNSYLVANIA AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11207-6307
Practice Address - Country:US
Practice Address - Phone:718-257-7000
Practice Address - Fax:718-257-7454
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2008-04-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY173632208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY39F773Medicare PIN