Provider Demographics
NPI:1659338259
Name:LOMBARDI, ANDREA MICHELLE
Entity Type:Individual
Prefix:MS
First Name:ANDREA
Middle Name:MICHELLE
Last Name:LOMBARDI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 RICHARD CT
Mailing Address - Street 2:
Mailing Address - City:POMONA
Mailing Address - State:NY
Mailing Address - Zip Code:10970-2308
Mailing Address - Country:US
Mailing Address - Phone:845-634-2460
Mailing Address - Fax:845-634-2190
Practice Address - Street 1:350 S MAIN ST
Practice Address - Street 2:
Practice Address - City:NEW CITY
Practice Address - State:NY
Practice Address - Zip Code:10956-3002
Practice Address - Country:US
Practice Address - Phone:845-634-2460
Practice Address - Fax:845-634-2190
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY024376225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQ20Z71OtherBLUE CROSS BLUE SHIELD ID
NY024376OtherNYS LISCENSE NUMBER
NYQ20Z71OtherBLUE CROSS BLUE SHIELD ID