Provider Demographics
NPI:1881773109
Name:LOMBARDO, DEAN (DC,CDN)
Entity type:Individual
Prefix:DR
First Name:DEAN
Middle Name:
Last Name:LOMBARDO
Suffix:
Gender:M
Credentials:DC,CDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1585 SANTA BARBARA BLVD
Mailing Address - Street 2:STE A
Mailing Address - City:THE VILLAGES
Mailing Address - State:FL
Mailing Address - Zip Code:32159-6820
Mailing Address - Country:US
Mailing Address - Phone:352-430-2121
Mailing Address - Fax:352-430-2114
Practice Address - Street 1:752 PARK AVE
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:NY
Practice Address - Zip Code:11743-3900
Practice Address - Country:US
Practice Address - Phone:631-385-0207
Practice Address - Fax:631-385-1272
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-06
Last Update Date:2016-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX006509111N00000X
NY003726133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No133N00000XDietary & Nutritional Service ProvidersNutritionist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03P11Medicare ID - Type UnspecifiedMEDICARE NUTRITION
NYU17203Medicare UPIN
NYX46981Medicare ID - Type UnspecifiedMEDICARE CHIROPRACTOR