Coleen Moira Dizon, LPTA

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

License

40QB00365400 Issued in NJ

Practice address

5 Manor Dr Apt 3N
Newark, NJ 07106-3236

Phone

(858) 900-7854

NPI assigned

Jun 22, 2020

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1592784000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1592784000000",
    "number": "1730705203",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5 MANOR DR APT 3N",
            "city": "NEWARK",
            "state": "NJ",
            "postal_code": "071063236",
            "telephone_number": "858-900-7854"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5 MANOR DR APT 3N",
            "city": "NEWARK",
            "state": "NJ",
            "postal_code": "071063236",
            "telephone_number": "858-900-7854"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DIZON",
        "first_name": "COLEEN MOIRA",
        "credential": "LPTA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-06-22",
        "last_updated": "2020-06-22",
        "certification_date": "2020-06-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "NJ",
            "license": "40QB00365400",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Patrick Joseph Discepola, M.D.
• Vito Angelo Dituri, R.PH.
• Divine Health Emergency Medical Services
• Divine Medical Services, LLC
• Saladeem Dixon
• Dmdnj LLC
• Gabriela DO Rego Barros, DO
• Eric W Doane, DO
• Monica Dobbin, LCSW
• Mirona Dobri, MD

• Physical Therapy Assistant in Newark, NJ
• Providers in Newark, NJ by specialty
• Physical Therapy Assistant in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 22, 2020; 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.