Provider Demographics
NPI:1790014470
Name:LOMBARDO, JENNIFER M (PA)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:M
Last Name:LOMBARDO
Suffix:
Gender:
Credentials:PA
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:M
Other - Last Name:FORSBERG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:259 1ST ST
Mailing Address - Street 2:WINTHROP UNIVERSITY HOSPITAL
Mailing Address - City:MINEOLA
Mailing Address - State:NY
Mailing Address - Zip Code:11501-3957
Mailing Address - Country:US
Mailing Address - Phone:516-663-2384
Mailing Address - Fax:516-663-8288
Practice Address - Street 1:259 1ST ST
Practice Address - Street 2:WINTHROP UNIVERSITY HOSPITAL
Practice Address - City:MINEOLA
Practice Address - State:NY
Practice Address - Zip Code:11501-3957
Practice Address - Country:US
Practice Address - Phone:516-663-2384
Practice Address - Fax:516-663-8288
Is Sole Proprietor?:No
Enumeration Date:2009-12-09
Last Update Date:2025-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013572363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical