Healthcare Provider Details

I. General information

NPI: 1548598154
Provider Name (Legal Business Name): ANTHONY PHILLIP RANDAZZO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/20/2009
Last Update Date: 11/20/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

126 W 22ND ST
NEW YORK NY
10011-2417
US

IV. Provider business mailing address

126 W 22ND ST
NEW YORK NY
10011-2417
US

V. Phone/Fax

Practice location:
  • Phone: 917-734-3163
  • Fax: 718-416-3652
Mailing address:
  • Phone: 917-734-3163
  • Fax: 718-416-3652

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number177341-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: