Provider Demographics
NPI:1558396853
Name:NARENDRA V AMBANI MD
Entity Type:Organization
Organization Name:NARENDRA V AMBANI MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROPRIETOR
Authorized Official - Prefix:
Authorized Official - First Name:NARENDRA
Authorized Official - Middle Name:V
Authorized Official - Last Name:AMBANI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:610-377-3252
Mailing Address - Street 1:990 BLAKESLEE BLVD EAST
Mailing Address - Street 2:
Mailing Address - City:LEHIGHTON
Mailing Address - State:PA
Mailing Address - Zip Code:18235-8753
Mailing Address - Country:US
Mailing Address - Phone:610-377-3252
Mailing Address - Fax:610-826-1289
Practice Address - Street 1:990 BLAKESLEE BLVD EAST
Practice Address - Street 2:
Practice Address - City:LEHIGHTON
Practice Address - State:PA
Practice Address - Zip Code:18235-8753
Practice Address - Country:US
Practice Address - Phone:610-377-3252
Practice Address - Fax:610-826-1289
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD022000E208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0006116420001Medicaid
E63533Medicare UPIN