Provider Demographics
NPI:1457313769
Name:LOMBARDY, DIANE ELAINE (MD)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:ELAINE
Last Name:LOMBARDY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:380 NASSAU RD
Mailing Address - Street 2:LONG ISLAND FQHC, INC.
Mailing Address - City:ROOSEVELT
Mailing Address - State:NY
Mailing Address - Zip Code:11575-1343
Mailing Address - Country:US
Mailing Address - Phone:516-571-8600
Mailing Address - Fax:
Practice Address - Street 1:135 MAIN ST
Practice Address - Street 2:LONG ISLAND FQHC, INC.
Practice Address - City:HEMPSTEAD
Practice Address - State:NY
Practice Address - Zip Code:11550-2414
Practice Address - Country:US
Practice Address - Phone:516-571-8200
Practice Address - Fax:516-571-8221
Is Sole Proprietor?:No
Enumeration Date:2006-04-03
Last Update Date:2014-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY161624208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01326338Medicaid
NY01326338Medicaid
NY50D551Medicare PIN