Provider Demographics
NPI:1679018212
Name:DIZON, MARICAR B
Entity Type:Individual
Prefix:
First Name:MARICAR
Middle Name:B
Last Name:DIZON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:492 HAMILTON ST APT E
Mailing Address - Street 2:
Mailing Address - City:RAHWAY
Mailing Address - State:NJ
Mailing Address - Zip Code:07065-3345
Mailing Address - Country:US
Mailing Address - Phone:973-207-5725
Mailing Address - Fax:
Practice Address - Street 1:799 MORRIS PARK AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10462-3604
Practice Address - Country:US
Practice Address - Phone:718-684-6300
Practice Address - Fax:718-684-6301
Is Sole Proprietor?:No
Enumeration Date:2017-01-05
Last Update Date:2022-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP96335225100000X
NY048734-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist