Provider Demographics
NPI:1710921879
Name:DISE, CRAIG ALLEN (MD)
Entity Type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:ALLEN
Last Name:DISE
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:100 MADISON AVE
Mailing Address - Street 2:PATHOLOGY
Mailing Address - City:MORRISTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07960-6136
Mailing Address - Country:US
Mailing Address - Phone:973-971-4251
Mailing Address - Fax:973-290-7370
Practice Address - Street 1:100 MADISON AVE
Practice Address - Street 2:PATHOLOGY
Practice Address - City:MORRISTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07960-6136
Practice Address - Country:US
Practice Address - Phone:973-971-4251
Practice Address - Fax:973-290-7370
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA04478500207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology