Provider Demographics
NPI:1982889713
Name:FRED LOMBARDO, PC
Entity Type:Organization
Organization Name:FRED LOMBARDO, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:TONIA
Authorized Official - Middle Name:
Authorized Official - Last Name:AVERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-283-5525
Mailing Address - Street 1:576 WYOMING AVE
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:PA
Mailing Address - Zip Code:18704-3702
Mailing Address - Country:US
Mailing Address - Phone:570-283-5525
Mailing Address - Fax:570-714-9638
Practice Address - Street 1:576 WYOMING AVE
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:PA
Practice Address - Zip Code:18704-3702
Practice Address - Country:US
Practice Address - Phone:570-283-5525
Practice Address - Fax:570-714-9638
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-28
Last Update Date:2008-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC004059L213ES0000X
332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0000XPodiatric Medicine & Surgery Service ProvidersPodiatristSports MedicineGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
20816OtherGEISINGER
1470984OtherBSM
60054OtherAETNA
814530OtherFIRST PRIORITY
60054OtherAETNA
814530OtherFIRST PRIORITY
1470984OtherBSM