Provider Demographics
NPI:1538141296
Name:LOMBARDO, JOVIN C (MD)
Entity Type:Individual
Prefix:DR
First Name:JOVIN
Middle Name:C
Last Name:LOMBARDO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:137 BEACH 140TH ST
Mailing Address - Street 2:
Mailing Address - City:ROCKAWAY PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11694-1219
Mailing Address - Country:US
Mailing Address - Phone:718-318-8809
Mailing Address - Fax:718-836-0801
Practice Address - Street 1:7801 4TH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11209-3701
Practice Address - Country:US
Practice Address - Phone:718-836-6661
Practice Address - Fax:718-836-0801
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-17
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY097764207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00989280Medicaid
NY841161Medicare ID - Type Unspecified
NY00989280Medicaid