Basic Information
| Provider Information | |||||||||
| NPI: | 1821290156 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | DREW LOMBARDI, DMD & SUSAN RIDER, DDS, MSD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 810 ABBOTT BLVD | ||||||||
| Address2: | SUITE 301 | ||||||||
| City: | FORT LEE | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 070244151 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2012243600 | ||||||||
| FaxNumber: | 2018863443 | ||||||||
| Practice Location | |||||||||
| Address1: | 810 ABBOTT BLVD | ||||||||
| Address2: | SUITE 301 | ||||||||
| City: | FORT LEE | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 070244151 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2012243600 | ||||||||
| FaxNumber: | 2018863443 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/31/2007 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | LOMBARDI | ||||||||
| AuthorizedOfficialFirstName: | DREW | ||||||||
| AuthorizedOfficialMiddleName: | RICHARD | ||||||||
| AuthorizedOfficialTitleorPosition: | PARTNER, ORTHODONTIST | ||||||||
| AuthorizedOfficialTelephone: | 2012243600 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | D.M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223X0400X | 22DI01356700 | NJ | Y | 193400000X SINGLE SPECIALTY GROUP | Dental Providers | Dentist | Orthodontics and Dentofacial Orthopedics |
No ID Information.