Healthcare Provider Details

I. General information

NPI: 1164721205
Provider Name (Legal Business Name): DEAN LOMBARDO CHIROPRACTIC AND NUTRITIONIST PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/15/2011
Last Update Date: 05/10/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

752 PARK AVE
HUNTINGTON NY
11743-3900
US

IV. Provider business mailing address

752 PARK AVE
HUNTINGTON NY
11743-3900
US

V. Phone/Fax

Practice location:
  • Phone: 631-385-0207
  • Fax: 631-385-1272
Mailing address:
  • Phone: 631-385-0207
  • Fax: 631-385-1272

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberX006509
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number003726
License Number StateNY

VIII. Authorized Official

Name: DR. DEAN LOMBARDO
Title or Position: CHIROPRACTOR/NUTRITIONIST
Credential: DC, CDN
Phone: 631-385-0207