Provider Demographics
NPI:1871257121
Name:D'AMBROSIO, LUCA
Entity Type:Individual
Prefix:
First Name:LUCA
Middle Name:
Last Name:D'AMBROSIO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:165 BEACH 147TH ST
Mailing Address - Street 2:
Mailing Address - City:NEPONSIT
Mailing Address - State:NY
Mailing Address - Zip Code:11694-1009
Mailing Address - Country:US
Mailing Address - Phone:917-767-3251
Mailing Address - Fax:
Practice Address - Street 1:165 BEACH 147TH ST
Practice Address - Street 2:
Practice Address - City:NEPONSIT
Practice Address - State:NY
Practice Address - Zip Code:11694-1009
Practice Address - Country:US
Practice Address - Phone:917-767-3251
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-22
Last Update Date:2021-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer