Provider Demographics
NPI:1407838691
Name:RANDAZZO, VINCENT (MD)
Entity type:Individual
Prefix:
First Name:VINCENT
Middle Name:
Last Name:RANDAZZO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:VINCENT
Other - Middle Name:T
Other - Last Name:RANDAZZO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 8519
Mailing Address - Street 2:
Mailing Address - City:RED BANK
Mailing Address - State:NJ
Mailing Address - Zip Code:07701-8519
Mailing Address - Country:US
Mailing Address - Phone:732-460-9840
Mailing Address - Fax:732-460-9848
Practice Address - Street 1:248 BROAD ST
Practice Address - Street 2:
Practice Address - City:RED BANK
Practice Address - State:NJ
Practice Address - Zip Code:07701-2020
Practice Address - Country:US
Practice Address - Phone:732-530-3433
Practice Address - Fax:732-758-1953
Is Sole Proprietor?:No
Enumeration Date:2005-11-15
Last Update Date:2007-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1416707Medicaid
NJ0K4741OtherHEALTH NET
NY950251OtherEMPIRE BC/BS
546837OtherAETNA HMO
NJ6731746OtherCIGNA
NY950252OtherEMPIRE BC/BS
NJMP175OtherOXFORD
NJ274026OtherUNITED HEALTHCARE
081855DCHMedicare ID - Type Unspecified
NJ1416707Medicaid