Individual
DR. MICHAEL MAZZA AMBROSINO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
560 1ST AVE, NEW YORK, NY 10016-6402
(212) 263-6369
Mailing address
3367 165TH ST, FLUSHING, NY 11358-1443
(212) 263-6369
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
155507
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01706734
—
NY
Enumeration date
04/13/2006
Last updated
08/03/2010
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