Provider Demographics
NPI:1427113844
Name:LOMBARDO, MARYANNE (DC)
Entity type:Individual
Prefix:DR
First Name:MARYANNE
Middle Name:
Last Name:LOMBARDO
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1210
Mailing Address - Street 2:
Mailing Address - City:SOUTH FALLSBURG
Mailing Address - State:NY
Mailing Address - Zip Code:12779-1210
Mailing Address - Country:US
Mailing Address - Phone:845-292-0702
Mailing Address - Fax:
Practice Address - Street 1:1980 STATE ROUTE 52
Practice Address - Street 2:
Practice Address - City:LIBERTY
Practice Address - State:NY
Practice Address - Zip Code:12754-8322
Practice Address - Country:US
Practice Address - Phone:845-292-0702
Practice Address - Fax:845-292-0702
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX006278-1111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYX50201Medicare ID - Type Unspecified