Provider Demographics
NPI:1477688620
Name:AMBROSINO, ROSA (DDS)
Entity Type:Individual
Prefix:MS
First Name:ROSA
Middle Name:
Last Name:AMBROSINO
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:ROSA
Other - Middle Name:MARIA
Other - Last Name:AMBROSINO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:222 E 34TH ST
Mailing Address - Street 2:APT 2323
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-4842
Mailing Address - Country:US
Mailing Address - Phone:708-790-6933
Mailing Address - Fax:
Practice Address - Street 1:150 BROADWAY
Practice Address - Street 2:SUITE1310
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10038-4381
Practice Address - Country:US
Practice Address - Phone:212-587-0202
Practice Address - Fax:212-587-8829
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2011-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019027017122300000X
NY055447-1122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL9185622Medicaid