Provider Demographics
NPI:1821070327
Name:AMBROSINO, JOHN J (MD)
Entity Type:Individual
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First Name:JOHN
Middle Name:J
Last Name:AMBROSINO
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Gender:M
Credentials:MD
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Mailing Address - Street 1:43 NEW SCOTLAND AVE
Mailing Address - Street 2:MC 157
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12208-3412
Mailing Address - Country:US
Mailing Address - Phone:518-262-5640
Mailing Address - Fax:518-262-9413
Practice Address - Street 1:117 MARYS AVE
Practice Address - Street 2:SUITE 202
Practice Address - City:KINGSTON
Practice Address - State:NY
Practice Address - Zip Code:12401-5849
Practice Address - Country:US
Practice Address - Phone:845-338-1992
Practice Address - Fax:845-338-1614
Is Sole Proprietor?:No
Enumeration Date:2005-11-18
Last Update Date:2015-05-27
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Provider Licenses
StateLicense IDTaxonomies
NY2781002086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY04059683Medicaid
NYA400121446Medicare PIN
NYJ400213278Medicare PIN