Basic Information
Provider Information | |||||||||
NPI: | 1083008445 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | LOMBARDO | ||||||||
FirstName: | MICHELLE | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 33 LEWIS RD | ||||||||
Address2: | 2ND FL | ||||||||
City: | BINGHAMTON | ||||||||
State: | NY | ||||||||
PostalCode: | 13905 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6077700025 | ||||||||
FaxNumber: | 6077293982 | ||||||||
Practice Location | |||||||||
Address1: | 42 W MAIN ST | ||||||||
Address2: |   | ||||||||
City: | OWEGO | ||||||||
State: | NY | ||||||||
PostalCode: | 138271578 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6076870350 | ||||||||
FaxNumber: | 6076870333 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 03/24/2015 | ||||||||
LastUpdateDate: | 06/03/2021 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 06/03/2021 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | MD16187 | RI | N |   | Allopathic & Osteopathic Physicians | Family Medicine |   | 207Q00000X | 300133 | NY | Y |   | Allopathic & Osteopathic Physicians | Family Medicine |   |
No ID Information.