Provider Demographics
NPI:1245260835
Name:D'AMBROSIO, STEPHEN (MPAS, PA-C)
Entity type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:
Last Name:D'AMBROSIO
Suffix:
Gender:M
Credentials:MPAS, PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 ELMWOOD AVE BOX 648
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14642-0001
Mailing Address - Country:US
Mailing Address - Phone:585-275-2734
Mailing Address - Fax:585-273-1033
Practice Address - Street 1:601 ELMWOOD AVE
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14642-2665
Practice Address - Country:US
Practice Address - Phone:585-275-1839
Practice Address - Fax:585-473-4861
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2023-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY6493363A00000X
NY006493363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYS60242Medicare UPIN
NYPA0997Medicare PIN