Provider Demographics
NPI:1164721205
Name:DEAN LOMBARDO CHIROPRACTIC AND NUTRITIONIST PC
Entity Type:Organization
Organization Name:DEAN LOMBARDO CHIROPRACTIC AND NUTRITIONIST PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR/NUTRITIONIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DEAN
Authorized Official - Middle Name:
Authorized Official - Last Name:LOMBARDO
Authorized Official - Suffix:
Authorized Official - Credentials:DC, CDN
Authorized Official - Phone:631-385-0207
Mailing Address - Street 1:752 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11743-3900
Mailing Address - Country:US
Mailing Address - Phone:631-385-0207
Mailing Address - Fax:631-385-1272
Practice Address - Street 1:752 PARK AVE
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:NY
Practice Address - Zip Code:11743-3900
Practice Address - Country:US
Practice Address - Phone:631-385-0207
Practice Address - Fax:631-385-1272
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-15
Last Update Date:2011-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX006509111N00000X
NY003726133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133N00000XDietary & Nutritional Service ProvidersNutritionistGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03P011Medicare PIN
NYX46981Medicare PIN