Kevin Dishon, PT, DPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

40QA01703300 Issued in NJ

Practice address

1255 Broad St
Suite 207
Bloomfield, NJ 07003-3000

Phone

(973) 893-9300

Fax

(973) 893-0073

NPI assigned

Aug 1, 2014

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1406851200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1479686400000",
    "number": "1518375617",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4175 VETERANS MEMORIAL HWY",
            "address_2": "SUITE 202",
            "city": "RONKONKOMA",
            "state": "NY",
            "postal_code": "117797639",
            "telephone_number": "631-580-5200",
            "fax_number": "631-580-5222"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1255 BROAD ST",
            "address_2": "SUITE 207",
            "city": "BLOOMFIELD",
            "state": "NJ",
            "postal_code": "070033000",
            "telephone_number": "973-893-9300",
            "fax_number": "973-893-0073"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DISHON",
        "first_name": "KEVIN",
        "credential": "PT, DPT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-08-01",
        "last_updated": "2016-11-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "CT",
            "license": "10224",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NJ",
            "license": "40QA01703300",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Susana Diaz
• Xavier Miguel Diaz, PHARMD
• Allison Dickens, LPC
• Bernedette Dimbo
• William Ding, M.D.
• Joseph M. Distefano, D.M.D.
• Joseph S. Distefano, DMD
• Jonathan W. Ditkoff, M.D.
• Janice Dittelman, MASTER OF SCIENCE
• Divine Aid Services

• Physical Therapist in Bloomfield, NJ
• Providers in Bloomfield, NJ by specialty
• Physical Therapist in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 21, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.