Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | 284417 | NY |
NPI | 1023017332 |
---|---|
Provider Name | Louis Dizon |
First Address | New York, NY 10003-3804 |
Second Address | New York, NY 10003-3804 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/07/2005 |
Last Update Date | 02/11/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1023017332 | (05) | VA |
TN01KA | JOHN DEERE TENNCARE (01) | TN |