MEDICARE: MICHAEL JOSEPH LOMBINO MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2085R0202X	Diagnostic Radiology Physician	260805	NY
2	2085R0202X	Diagnostic Radiology Physician	25MA08974100	NJ
3	2085R0202X	Diagnostic Radiology Physician	50108	CT

General Provider Information

NPI Number	:	1194933911
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL JOSEPH LOMBINO MD

Provider Business Mailing Address
First Line	:	20 FRANKLIN TPKE
Second Line	:
City	:	WALDWICK
State	:	NJ
Zip	:	07463-1749
Country	:	US
Telephone Number	:	201-445-3044
Fax Number	:

Provider Business Practice Location Address
First Line	:	223 N VAN DIEN AVE
Second Line	:
City	:	RIDGEWOOD
State	:	NJ
Zip	:	07450-2736
Country	:	US
Telephone Number	:	201-447-8000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/18/2007
Last Update Date	:	03/08/2023

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