Provider Demographics
NPI:1497883623
Name:DIZON, CHARITO A (CRNA)
Entity Type:Individual
Prefix:MS
First Name:CHARITO
Middle Name:A
Last Name:DIZON
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:207 BENNINGTON TER
Mailing Address - Street 2:
Mailing Address - City:PARAMUS
Mailing Address - State:NJ
Mailing Address - Zip Code:07652-1335
Mailing Address - Country:US
Mailing Address - Phone:201-790-1582
Mailing Address - Fax:
Practice Address - Street 1:133 LAFAYETTE AVE
Practice Address - Street 2:
Practice Address - City:SUFFERN
Practice Address - State:NY
Practice Address - Zip Code:10901-5614
Practice Address - Country:US
Practice Address - Phone:845-357-5770
Practice Address - Fax:845-357-8263
Is Sole Proprietor?:No
Enumeration Date:2007-03-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY334662367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYR8A3910Medicare ID - Type Unspecified