=====================================================
General NPI Number Information
=====================================================
NPI Number | 1780842773
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CATHY ANN LOMBARDO
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/28/2008
-----------------------------------------------------
Last Update Date | 03/31/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 650 COMMACK RD
-----------------------------------------------------
City | COMMACK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11725-5404
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 631-424-7780
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 324 JEFFERSON ST
-----------------------------------------------------
City | CENTERPORT
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11721-1333
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 631-424-7780
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | F335713-1
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 163W00000X
-----------------------------------------------------
Taxonomy Name | Registered Nurse
-----------------------------------------------------
License Number | 361481-1
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------