Provider Demographics
NPI:1558963181
Name:AMBATT, GLENIS
Entity Type:Individual
Prefix:
First Name:GLENIS
Middle Name:
Last Name:AMBATT
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 1:32 SHERWOOD DR
Mailing Address - Street 2:
Mailing Address - City:NANUET
Mailing Address - State:NY
Mailing Address - Zip Code:10954-2524
Mailing Address - Country:US
Mailing Address - Phone:586-872-9877
Mailing Address - Fax:
Practice Address - Street 1:4 MEDICAL PARK DR STE B
Practice Address - Street 2:
Practice Address - City:POMONA
Practice Address - State:NY
Practice Address - Zip Code:10970-3572
Practice Address - Country:US
Practice Address - Phone:845-625-2810
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-09
Last Update Date:2020-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist