Healthcare Provider Details

I. General information

NPI: 1700862919
Provider Name (Legal Business Name): DOMENICK N RANDAZZO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/20/2005
Last Update Date: 01/31/2022
Certification Date: 01/31/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8 TEMPE WICK RD
MENDHAM NJ
07945-1814
US

IV. Provider business mailing address

PO BOX 416457
BOSTON MA
02241-1735
US

V. Phone/Fax

Practice location:
  • Phone: 973-543-2288
  • Fax: 973-543-0637
Mailing address:
  • Phone: 844-362-1735
  • Fax: 973-290-7495

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberMA56798
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number25MA05679800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: