Provider Demographics
NPI:1508885740
Name:DAMBROSIA, GERALD JOSEPH (MD)
Entity Type:Individual
Prefix:DR
First Name:GERALD
Middle Name:JOSEPH
Last Name:DAMBROSIA
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 1:100 ROUTE 59 STE 103A
Mailing Address - Street 2:
Mailing Address - City:SUFFERN
Mailing Address - State:NY
Mailing Address - Zip Code:10901-4927
Mailing Address - Country:US
Mailing Address - Phone:845-368-4800
Mailing Address - Fax:845-369-1697
Practice Address - Street 1:128 ASHFORD AVE
Practice Address - Street 2:
Practice Address - City:DOBBS FERRY
Practice Address - State:NY
Practice Address - Zip Code:10522-1924
Practice Address - Country:US
Practice Address - Phone:845-368-4800
Practice Address - Fax:845-369-1697
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY140636207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01462986Medicaid
NYB75356Medicare UPIN
NY093F861Medicare ID - Type UnspecifiedMEDICARE INDIVIDUAL NUMBE