1780842773 NPI number — CATHY ANN LOMBARDO

Table of content: DEBRA R GORE M.D. (NPI 1306984646)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780842773 NPI number — CATHY ANN LOMBARDO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LOMBARDO
Provider First Name:
CATHY ANN
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
LOMBARDO
Provider Other First Name:
CATHY ANN
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
RN
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1780842773
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/31/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
324 JEFFERSON ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CENTERPORT
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11721-1333
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
631-424-7780
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
650 COMMACK RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COMMACK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11725-5404
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
631-424-7780
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/28/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 163W00000X , with the licence number:  361481-1 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 363LF0000X , with the licence number: F335713-1 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)