Provider Demographics
NPI:1104424225
Name:LOMBARDI-MARINO WELLNESS INSTITUTE
Entity type:Organization
Organization Name:LOMBARDI-MARINO WELLNESS INSTITUTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:
Authorized Official - Last Name:MARINO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:833-564-9355
Mailing Address - Street 1:40 CORBETT WAY
Mailing Address - Street 2:
Mailing Address - City:EATONTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07724-2263
Mailing Address - Country:US
Mailing Address - Phone:833-564-9355
Mailing Address - Fax:
Practice Address - Street 1:40 CORBETT WAY
Practice Address - Street 2:
Practice Address - City:EATONTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07724-2263
Practice Address - Country:US
Practice Address - Phone:833-564-9355
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-12
Last Update Date:2020-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1750732954OtherNPI