Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251P0200X | Physical Therapist - Pediatrics | 022007-1 | NY |
NPI | 1003180134 |
---|---|
Provider Name | Mr. Ramoncito Tiosejo Dizon |
First Address | New York, NY 10017-6839 |
Second Address | New York, NY 10029-3513 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/03/2012 |
Last Update Date | 26/04/2012 |