Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0100X | Gastroenterologist | 25MA06172900 | NJ |
NPI | 1003926932 |
---|---|
Provider Name | Dr. Alita Logrono Dizon |
First Address | Jersey City, NJ 07302-4325 |
Second Address | Jersey City, NJ 07302-4325 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/08/2006 |
Last Update Date | 26/10/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1067339 | HORIZON NJ HEALTH (01) | NJ |
21149154242 | BEECH STREET (01) | NJ |
23165 | UHP (01) | NJ |
2702975014 | CIGNA (01) | NJ |
2702975016 | CIGNA (01) | NJ |
41N14 | EMPIRE BCBS (01) | NY |
5097587 | AETNA (01) | NJ |
7437901 | (05) | NJ |
G58423 | (02) | NJ |
P2673595 | OXFORD (01) | NJ |