Ambrose Mgbako, MD

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

License

25MA06256300 Issued in NJ

Practice address

1 Bay Ave
Montclair, NJ 07042-4837

Phone

(973) 971-5595

NPI assigned

Mar 2, 2006

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in NJ

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Psychiatry

Education

Other, 1972

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Eoh Acquisition Group, LLCGroup PAC ID 4082009717, 38 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: amgbako188817@ahs.direct-ci.com

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Eoh Acquisition Group, LLC

  • Psychiatry Physician
  • East Orange, NJ
  • NPI 1760851893
  Medicare reassignment Care Compare group
• Eoh Acquisition Group, LLC

  • General Acute Care Hospital
  • East Orange, NJ
  • NPI 1013386143
  NPD
• Practice Associates,Inc

  • Physician Assistant
  • Morristown, NJ
  • NPI 1699733907

  Psychiatry

  NPD (past)
• Specialty Care of Practice Associates,PA

  • Specialist
  • Morristown, NJ
  • NPI 1215985908
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1141257600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1280793600000",
    "number": "1629045323",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 23831",
            "city": "NEWARK",
            "state": "NJ",
            "postal_code": "071890001",
            "telephone_number": "973-971-5595"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 BAY AVE",
            "city": "MONTCLAIR",
            "state": "NJ",
            "postal_code": "070424837",
            "telephone_number": "973-971-5595"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MGBAKO",
        "first_name": "AMBROSE",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-03-02",
        "last_updated": "2010-08-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "NJ",
            "license": "25MA06256300",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1488902",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Emmanuel Mervilus
• Ashley Engle Meskill, NP
• Jolinda Mester, MD
• Sarah E Meyer, M.D.
• Natalya Meyerzon, PMHNP
• Deanna R Michael
• David Middlemas, ED.D., ATC
• Joyce Mierzejwski, LPC
• Aleksandra Mihajlovic, L.AC.
• Pratika Mikkilineni, MD

• Psychiatry Physician in Montclair, NJ
• Providers in Montclair, NJ by specialty
• Psychiatry Physician in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 3, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.