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General NPI Number Information
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NPI Number | 1639372022
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Entity Type | Individual
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Provider Name | JON JOSEPH RANDAZZO DC
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Gender | Male
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Dates
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Enumeration Date | 06/06/2007
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Last Update Date | 10/06/2011
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Provider Practice Location Address
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Address Line | 10515 LIBERTY AVE
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City | OZONE PARK
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State | NY
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Zip | 11417-1809
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Country | US
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Telephone | 718-843-7720
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 70160
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City | STATEN ISLAND
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State | NY
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Zip | 10307-0160
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Country | US
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Telephone | 718-843-7720
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | X007603-1
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License Number State | NY
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