Provider Demographics
NPI:1841343969
Name:DAYRIT, PEDRO QUIZON (MD)
Entity type:Individual
Prefix:
First Name:PEDRO
Middle Name:QUIZON
Last Name:DAYRIT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 POINTERS AUBURN RD
Mailing Address - Street 2:MANNINGTON MEDICAL OFFICE
Mailing Address - City:SALEM
Mailing Address - State:NJ
Mailing Address - Zip Code:08079-4311
Mailing Address - Country:US
Mailing Address - Phone:856-935-8900
Mailing Address - Fax:856-935-9399
Practice Address - Street 1:5 POINTERS AUBURN RD
Practice Address - Street 2:MANNINGTON MEDICAL OFFICE
Practice Address - City:SALEM
Practice Address - State:NJ
Practice Address - Zip Code:08079-4311
Practice Address - Country:US
Practice Address - Phone:856-935-8900
Practice Address - Fax:856-935-9399
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-19
Last Update Date:2008-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA03916300207RG0100X
DEC1-0002304207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0595004Medicaid
DE0000214601Medicaid
NJC53811Medicare UPIN
NJ188195Medicare PIN
DE0000214601Medicaid