Provider Demographics
NPI:1679660435
Name:LOMBARDI, PAUL
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:
Last Name:LOMBARDI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1446
Mailing Address - Street 2:
Mailing Address - City:MORRISTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07962-1446
Mailing Address - Country:US
Mailing Address - Phone:973-538-2334
Mailing Address - Fax:973-538-4081
Practice Address - Street 1:160 HANOVER AVENUE
Practice Address - Street 2:
Practice Address - City:MORRISTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07962
Practice Address - Country:US
Practice Address - Phone:973-538-2334
Practice Address - Fax:973-538-4081
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2008-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA06884600174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ5713658OtherGHI PPO#
NJ2173434OtherAETNA HMO#
NJ0860671000OtherAMERIHEALTH #
NJ5916799OtherAETNA PPO#
NJI20361OtherAMERIHEALTH ADM#
NJ7981503Medicaid
NJ0860671000OtherAMERIHEALTH #
NJ2173434OtherAETNA HMO#