Provider Demographics
NPI:1245281286
Name:LOMBARDO, GERARD (MD)
Entity type:Individual
Prefix:DR
First Name:GERARD
Middle Name:
Last Name:LOMBARDO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 ROSE PL
Mailing Address - Street 2:2ND FLOOR, SUITE A
Mailing Address - City:NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11040-5312
Mailing Address - Country:US
Mailing Address - Phone:718-680-3800
Mailing Address - Fax:
Practice Address - Street 1:9101 4TH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11209-6368
Practice Address - Country:US
Practice Address - Phone:718-680-3800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-15
Last Update Date:2014-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY159753207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01109668Medicaid
NYA64145Medicare UPIN
NY01109668Medicaid