Provider Demographics
NPI:1205047461
Name:AMBRUSKO, STEVEN JOHN (MD)
Entity type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:JOHN
Last Name:AMBRUSKO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1001 MAIN ST FL 5
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14203-1009
Mailing Address - Country:US
Mailing Address - Phone:716-323-0000
Mailing Address - Fax:716-323-0290
Practice Address - Street 1:ELM AT CARLTON STREETS
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14263-2006
Practice Address - Country:US
Practice Address - Phone:716-845-4447
Practice Address - Fax:716-845-3588
Is Sole Proprietor?:No
Enumeration Date:2007-05-26
Last Update Date:2021-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2304232080P0207X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0207XAllopathic & Osteopathic PhysiciansPediatricsPediatric Hematology-Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
00028091301OtherUNIVERA
000529373001OtherBC/BS
070905000009OtherFIDELIS
NY02903271Medicaid
1214321OtherIHA
000529373002OtherBC/BS
000529373002OtherBC/BS