Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251X0800X | Physical Therapist - Orthopedic | 028748 | NY |
NPI | 1013146166 |
---|---|
Provider Name | Dr. Donna Jose-Dizon |
First Address | Syosset, NY 11791-3717 |
Second Address | Bellerose, NY 11426-1414 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/07/2009 |
Last Update Date | 11/11/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
028748 | PT LICENSE # (01) | NY |
03131000 | (05) | NY |
1164851671 | ORGANIZATION NPI (01) | |
37085 | PT LICENSE # (01) | CA |
40QA01330300 | PT LICENSE # (01) | NJ |
6723976 | REGISTRATION CERTIFICATE (01) | NY |