Provider Demographics
NPI:1801497433
Name:DIZON, MITCHELL
Entity type:Individual
Prefix:MR
First Name:MITCHELL
Middle Name:
Last Name:DIZON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1019 COLUMBUS AVE
Mailing Address - Street 2:
Mailing Address - City:WESTFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07090-1619
Mailing Address - Country:US
Mailing Address - Phone:908-239-8627
Mailing Address - Fax:551-278-0727
Practice Address - Street 1:1019 COLUMBUS AVE
Practice Address - Street 2:
Practice Address - City:WESTFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07090-1619
Practice Address - Country:US
Practice Address - Phone:908-239-8627
Practice Address - Fax:551-278-0727
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-02
Last Update Date:2020-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246QM0706XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, PathologyMedical TechnologistGroup - Single Specialty