Healthcare Provider Details

I. General information

NPI: 1609749381
Provider Name (Legal Business Name): ANTHONY LOMBARDO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/29/2025
Last Update Date: 09/29/2025
Certification Date: 09/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24 RAYMOND AVE
NUTLEY NJ
07110-2235
US

IV. Provider business mailing address

24 RAYMOND AVE
NUTLEY NJ
07110-2235
US

V. Phone/Fax

Practice location:
  • Phone: 201-956-8420
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number26NR18918600
License Number StateNJ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: