Provider Demographics
NPI:1972753044
Name:LOMBARDO, MARY W (RN,BSN,MSN)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:W
Last Name:LOMBARDO
Suffix:
Gender:F
Credentials:RN,BSN,MSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:411 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CATSKILL
Mailing Address - State:NY
Mailing Address - Zip Code:12414-1363
Mailing Address - Country:US
Mailing Address - Phone:518-719-3600
Mailing Address - Fax:518-719-3783
Practice Address - Street 1:411 MAIN ST
Practice Address - Street 2:
Practice Address - City:CATSKILL
Practice Address - State:NY
Practice Address - Zip Code:12414-1363
Practice Address - Country:US
Practice Address - Phone:518-719-3600
Practice Address - Fax:518-719-3783
Is Sole Proprietor?:No
Enumeration Date:2008-09-25
Last Update Date:2008-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY367035-1163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYWZZYW1OtherMEDICARE B