Provider Demographics
NPI:1609281047
Name:AMBROSE, TAMARA (MSED)
Entity Type:Individual
Prefix:
First Name:TAMARA
Middle Name:
Last Name:AMBROSE
Suffix:
Gender:F
Credentials:MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14415 FARMERS BLVD
Mailing Address - Street 2:
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11434-5953
Mailing Address - Country:US
Mailing Address - Phone:347-249-2909
Mailing Address - Fax:718-525-0240
Practice Address - Street 1:14415 FARMERS BLVD
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11434-5953
Practice Address - Country:US
Practice Address - Phone:347-249-2909
Practice Address - Fax:718-525-0240
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-24
Last Update Date:2014-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist