Healthcare Provider Details

I. General information

NPI: 1295748846
Provider Name (Legal Business Name): RUSSELL MATHEW LAMBOY DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/14/2006
Last Update Date: 05/07/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

245 CONKLIN ST
FARMINGDALE NY
11735-2608
US

IV. Provider business mailing address

245 CONKLIN ST
FARMINGDALE NY
11735-2608
US

V. Phone/Fax

Practice location:
  • Phone: 516-249-4488
  • Fax: 516-249-4058
Mailing address:
  • Phone: 516-249-4488
  • Fax: 516-249-4058

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NR0200X
TaxonomyRadiology Chiropractor
License NumberX010041-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: