Provider Demographics
NPI:1750340444
Name:VALLONE, AMBROSE (MD)
Entity type:Individual
Prefix:DR
First Name:AMBROSE
Middle Name:
Last Name:VALLONE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:100 PORT WASHINGTON BLVD
Mailing Address - Street 2:SUITE 108
Mailing Address - City:ROSLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11576-1353
Mailing Address - Country:US
Mailing Address - Phone:516-365-3340
Mailing Address - Fax:516-365-5512
Practice Address - Street 1:100 PORT WASHINGTON BLVD
Practice Address - Street 2:SUITE 108
Practice Address - City:ROSLYN
Practice Address - State:NY
Practice Address - Zip Code:11576-1353
Practice Address - Country:US
Practice Address - Phone:516-365-3340
Practice Address - Fax:516-365-5512
Is Sole Proprietor?:No
Enumeration Date:2006-03-21
Last Update Date:2011-02-23
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY1752392080P0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYC22899Medicare UPIN