Provider Demographics
NPI:1700893930
Name:D'AMBROSIO, JOSEPH (PT)
Entity Type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:
Last Name:D'AMBROSIO
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 ROBIN CT
Mailing Address - Street 2:
Mailing Address - City:STONY BROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11790-3201
Mailing Address - Country:US
Mailing Address - Phone:631-715-2634
Mailing Address - Fax:
Practice Address - Street 1:5 ROBIN CT
Practice Address - Street 2:
Practice Address - City:STONY BROOK
Practice Address - State:NY
Practice Address - Zip Code:11790-3201
Practice Address - Country:US
Practice Address - Phone:631-715-2634
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2014-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007834225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist