Provider Demographics
NPI:1669564431
Name:AMBROSIO, GEORGE J (MD)
Entity type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:J
Last Name:AMBROSIO
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 1:50 POMPTON AVE
Mailing Address - Street 2:
Mailing Address - City:VERONA
Mailing Address - State:NJ
Mailing Address - Zip Code:07044-2917
Mailing Address - Country:US
Mailing Address - Phone:973-857-3400
Mailing Address - Fax:973-857-7034
Practice Address - Street 1:50 POMPTON AVE
Practice Address - Street 2:
Practice Address - City:VERONA
Practice Address - State:NJ
Practice Address - Zip Code:07044-2917
Practice Address - Country:US
Practice Address - Phone:973-857-3400
Practice Address - Fax:973-857-7034
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA037714207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ07D661OtherWELL CHOICE
NJ110086025OtherRAIL ROAD MEDICARE
NJAMERIHEALTHOther402466
NJEP214OtherOXFORD
NJ514375OtherAETNA
NJOK2192OtherHEALTHNET
NJ514375OtherAETNA
NJAM402466Medicare ID - Type Unspecified