Provider Demographics
NPI:1275698037
Name:LOMBARDO, GAETANO (PT)
Entity Type:Individual
Prefix:
First Name:GAETANO
Middle Name:
Last Name:LOMBARDO
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1160 5TH AVE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10029-6928
Mailing Address - Country:US
Mailing Address - Phone:212-426-4700
Mailing Address - Fax:212-426-0006
Practice Address - Street 1:1160 5TH AVE
Practice Address - Street 2:SUITE 103
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10029-6928
Practice Address - Country:US
Practice Address - Phone:212-426-4700
Practice Address - Fax:212-426-0006
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011012225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP3656561OtherOXFORD
NYN91390OtherHEALTH NET
NYQ14U41OtherBLUE CROSS BLUE SHIELD
QB 2231Medicare UPIN