Provider Demographics
NPI:1023174471
Name:LOMBARDO, GARY GASPARE (MD)
Entity type:Individual
Prefix:
First Name:GARY
Middle Name:GASPARE
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 1:100 WOODS RD
Mailing Address - Street 2:
Mailing Address - City:VALHALLA
Mailing Address - State:NY
Mailing Address - Zip Code:10595-1530
Mailing Address - Country:US
Mailing Address - Phone:914-493-5213
Mailing Address - Fax:
Practice Address - Street 1:100 WOODS RD
Practice Address - Street 2:TAYLOR PAVILION E-135
Practice Address - City:VALHALLA
Practice Address - State:NY
Practice Address - Zip Code:10595-1530
Practice Address - Country:US
Practice Address - Phone:914-493-5213
Practice Address - Fax:914-493-5271
Is Sole Proprietor?:No
Enumeration Date:2006-12-29
Last Update Date:2013-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD428727208600000X, 2086S0102X
NY2408762086S0127X, 2086S0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical Care
No208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086S0127XAllopathic & Osteopathic PhysiciansSurgeryTrauma Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03077387Medicaid
NYA400020705Medicare PIN