Provider Demographics
NPI:1659579332
Name:AMBROSINO, CARRIE B (RPA-C)
Entity Type:Individual
Prefix:MS
First Name:CARRIE
Middle Name:B
Last Name:AMBROSINO
Suffix:
Gender:F
Credentials:RPA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1368
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12201-1368
Mailing Address - Country:US
Mailing Address - Phone:518-348-1276
Mailing Address - Fax:518-348-1279
Practice Address - Street 1:211 CHURCH ST
Practice Address - Street 2:
Practice Address - City:SARATOGA SPRINGS
Practice Address - State:NY
Practice Address - Zip Code:12866-1003
Practice Address - Country:US
Practice Address - Phone:518-583-8343
Practice Address - Fax:518-583-8386
Is Sole Proprietor?:No
Enumeration Date:2007-07-05
Last Update Date:2016-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011886363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY4937930001OtherMEDICARE DME
NY00473649Medicaid
NY00473649Medicaid
NYJ400001196Medicare PIN