Provider Demographics
NPI:1790960409
Name:D'AMBROSIO, JOSEPH R (PHARMD, RPH)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:R
Last Name:D'AMBROSIO
Suffix:
Gender:M
Credentials:PHARMD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:270 VOORHEES RD
Mailing Address - Street 2:
Mailing Address - City:AMSTERDAM
Mailing Address - State:NY
Mailing Address - Zip Code:12010-6268
Mailing Address - Country:US
Mailing Address - Phone:518-843-4668
Mailing Address - Fax:
Practice Address - Street 1:4894 STATE HIGHWAY 30
Practice Address - Street 2:
Practice Address - City:AMSTERDAM
Practice Address - State:NY
Practice Address - Zip Code:12010-7515
Practice Address - Country:US
Practice Address - Phone:518-843-4520
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-02
Last Update Date:2008-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY048843183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00483523Medicaid