MEDICARE: DR. ALITA LOGRONO DIZON M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RG0100X	Gastroenterology Physician	25MA06172900	NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P2673595	OTHER	NJ	OXFORD
2	2702975014	OTHER	NJ	CIGNA
3	41N14	OTHER	NY	EMPIRE BCBS
4	23165	OTHER	NJ	UHP
5	5097587	OTHER	NJ	AETNA
6	1067339	OTHER	NJ	HORIZON NJ HEALTH
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
8	21149154242	OTHER	NJ	BEECH STREET
9	2702975016	OTHER	NJ	CIGNA

General Provider Information

NPI Number	:	1003926932
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ALITA LOGRONO DIZON M.D.

Provider Business Mailing Address
First Line	:	377 JERSEY AVE
Second Line	:	SUITE 460
City	:	JERSEY CITY
State	:	NJ
Zip	:	07302-4325
Country	:	US
Telephone Number	:	201-332-4110
Fax Number	:	201-332-4122

Provider Business Practice Location Address
First Line	:	377 JERSEY AVE
Second Line	:	SUITE 460
City	:	JERSEY CITY
State	:	NJ
Zip	:	07302-4325
Country	:	US
Telephone Number	:	201-332-4110
Fax Number	:	201-332-4122

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/30/2006
Last Update Date	:	10/26/2010

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Directions to “ DR. ALITA LOGRONO DIZON M.D.” Practice Location

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