Provider Demographics
NPI:1639398316
Name:DRS. MALDONADO AND AMBROSIO
Entity Type:Organization
Organization Name:DRS. MALDONADO AND AMBROSIO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:G
Authorized Official - Last Name:AMBROSIO
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:973-694-9080
Mailing Address - Street 1:911 VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:WAYNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07470-2973
Mailing Address - Country:US
Mailing Address - Phone:973-694-9080
Mailing Address - Fax:
Practice Address - Street 1:911 VALLEY RD
Practice Address - Street 2:
Practice Address - City:WAYNE
Practice Address - State:NJ
Practice Address - Zip Code:07470-2973
Practice Address - Country:US
Practice Address - Phone:973-694-9080
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-24
Last Update Date:2010-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ156101223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty