Provider Demographics
NPI:1669654117
Name:DALAL, AMBRISH (MD)
Entity Type:Individual
Prefix:DR
First Name:AMBRISH
Middle Name:
Last Name:DALAL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:#2490
Mailing Address - Street 2:455 ROUTE 306
Mailing Address - City:MONSEY
Mailing Address - State:NY
Mailing Address - Zip Code:10952
Mailing Address - Country:US
Mailing Address - Phone:800-490-0509
Mailing Address - Fax:
Practice Address - Street 1:#2490
Practice Address - Street 2:455 ROUTE 306
Practice Address - City:MONSEY
Practice Address - State:NY
Practice Address - Zip Code:10952
Practice Address - Country:US
Practice Address - Phone:800-490-0509
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-27
Last Update Date:2007-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04322422085R0202X
IN01062858A2085R0202X
CAC528032085R0202X
VA01012410242085R0202X
FLME989132085R0202X
PAMD037154L2085R0202X
GA0590602085R0202X
UT6566960-12052085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology