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General NPI Number Information
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NPI Number | 1013146166
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Entity Type | Individual
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Provider Name | DONNA JOSE-DIZON DPT
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Gender | Female
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Dates
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Enumeration Date | 07/10/2009
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Last Update Date | 08/11/2022
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Provider Practice Location Address
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Address Line | 24519 JERICHO TPKE
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City | BELLEROSE
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State | NY
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Zip | 11426-1414
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Country | US
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Telephone | 718-343-6300
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Fax | 718-343-6311
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Provider Business Mailing Address
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Address Line | 5 EDNA DR
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City | SYOSSET
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State | NY
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Zip | 11791-3717
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Country | US
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Telephone | 516-802-0216
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Fax | 516-802-0216
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2251X0800X
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Taxonomy Name | Orthopedic Physical Therapist
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License Number | 028748
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License Number State | NY
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