Provider Demographics
NPI:1841290517
Name:AMBROSE, GUNASEELAN (MD)
Entity type:Individual
Prefix:DR
First Name:GUNASEELAN
Middle Name:
Last Name:AMBROSE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 REHILL AVE
Mailing Address - Street 2:SUITE 3300
Mailing Address - City:SOMERVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08876-2500
Mailing Address - Country:US
Mailing Address - Phone:908-927-8994
Mailing Address - Fax:908-927-8995
Practice Address - Street 1:30 REHILL AVE
Practice Address - Street 2:SUITE 3300
Practice Address - City:SOMERVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08876-2500
Practice Address - Country:US
Practice Address - Phone:908-927-8994
Practice Address - Fax:908-927-8995
Is Sole Proprietor?:No
Enumeration Date:2005-07-26
Last Update Date:2012-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY217173208600000X
NJ25MA07710100208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02166654Medicaid
H33079Medicare UPIN
NY222H22Medicare ID - Type Unspecified
NY02166654Medicaid