Provider Demographics
NPI:1144854001
Name:DIZON, GLADYS MAY CASAYURAN
Entity type:Individual
Prefix:MS
First Name:GLADYS MAY
Middle Name:CASAYURAN
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 1:5 MANOR DR APT 3N
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07106-3236
Mailing Address - Country:US
Mailing Address - Phone:862-333-8055
Mailing Address - Fax:
Practice Address - Street 1:343 THORNALL ST STE 510
Practice Address - Street 2:
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08837-2224
Practice Address - Country:US
Practice Address - Phone:862-333-8055
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-28
Last Update Date:2025-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEJ100040006225100000X
NJ40QA01914100225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist