Provider Demographics
NPI:1013146166
Name:JOSE-DIZON, DONNA (DPT)
Entity Type:Individual
Prefix:DR
First Name:DONNA
Middle Name:
Last Name:JOSE-DIZON
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 EDNA DR
Mailing Address - Street 2:
Mailing Address - City:SYOSSET
Mailing Address - State:NY
Mailing Address - Zip Code:11791-3717
Mailing Address - Country:US
Mailing Address - Phone:516-802-0216
Mailing Address - Fax:516-802-0216
Practice Address - Street 1:24519 JERICHO TPKE
Practice Address - Street 2:
Practice Address - City:BELLEROSE
Practice Address - State:NY
Practice Address - Zip Code:11426-1414
Practice Address - Country:US
Practice Address - Phone:718-343-6300
Practice Address - Fax:718-343-6311
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-10
Last Update Date:2022-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0287482251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY6723976OtherREGISTRATION CERTIFICATE
NY028748OtherPT LICENSE #
NY03131000Medicaid
1164851671OtherORGANIZATION NPI
NJ40QA01330300OtherPT LICENSE #
CA37085OtherPT LICENSE #