Healthcare Provider Details

I. General information

NPI: 1497883623
Provider Name (Legal Business Name): CHARITO A. DIZON CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/01/2007
Last Update Date: 07/07/2025
Certification Date: 07/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

133 LAFAYETTE AVE
SUFFERN NY
10901-5614
US

IV. Provider business mailing address

207 BENNINGTON TER
PARAMUS NJ
07652-1335
US

V. Phone/Fax

Practice location:
  • Phone: 845-357-5770
  • Fax: 845-357-8263
Mailing address:
  • Phone: 201-790-1582
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number334662
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number26NR08609300
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: