Provider Demographics
NPI:1922423847
Name:LOMBARDO, ANTHONY (RN)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:
Last Name:LOMBARDO
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32 DEER RUN
Mailing Address - Street 2:
Mailing Address - City:WATER MILL
Mailing Address - State:NY
Mailing Address - Zip Code:11976-2144
Mailing Address - Country:US
Mailing Address - Phone:631-680-7551
Mailing Address - Fax:
Practice Address - Street 1:32 DEER RUN
Practice Address - Street 2:
Practice Address - City:WATER MILL
Practice Address - State:NY
Practice Address - Zip Code:11976-2144
Practice Address - Country:US
Practice Address - Phone:631-680-7551
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-28
Last Update Date:2014-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY658920-1163WG0000X, 163WH0200X, 163WM1400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
No163WH0200XNursing Service ProvidersRegistered NurseHome Health
No163WM1400XNursing Service ProvidersRegistered NurseNurse Massage Therapist (NMT)