Provider Demographics
NPI:1003926932
Name:DIZON, ALITA LOGRONO (MD)
Entity Type:Individual
Prefix:DR
First Name:ALITA
Middle Name:LOGRONO
Last Name:DIZON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:377 JERSEY AVE
Mailing Address - Street 2:SUITE 460
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07302-4325
Mailing Address - Country:US
Mailing Address - Phone:201-332-4110
Mailing Address - Fax:201-332-4122
Practice Address - Street 1:377 JERSEY AVE
Practice Address - Street 2:SUITE 460
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07302-4325
Practice Address - Country:US
Practice Address - Phone:201-332-4110
Practice Address - Fax:201-332-4122
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2010-10-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA06172900207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJP2673595OtherOXFORD
NJ2702975014OtherCIGNA
NY41N14OtherEMPIRE BCBS
NJ23165OtherUHP
NJ5097587OtherAETNA
NJ1067339OtherHORIZON NJ HEALTH
NJ7437901Medicaid
NJ21149154242OtherBEECH STREET
NJ2702975016OtherCIGNA
NJ5097587OtherAETNA
NJ23165OtherUHP