Provider Demographics
NPI:1114116464
Name:RANDAZZO, CIRO GIUSEPPE (MD, MPH)
Entity Type:Individual
Prefix:DR
First Name:CIRO
Middle Name:GIUSEPPE
Last Name:RANDAZZO
Suffix:
Gender:M
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1057 COMMERCE AVE
Mailing Address - Street 2:
Mailing Address - City:UNION
Mailing Address - State:NJ
Mailing Address - Zip Code:07083-5025
Mailing Address - Country:US
Mailing Address - Phone:908-688-8800
Mailing Address - Fax:908-688-2377
Practice Address - Street 1:1057 COMMERCE AVE
Practice Address - Street 2:
Practice Address - City:UNION
Practice Address - State:NJ
Practice Address - Zip Code:07083-5025
Practice Address - Country:US
Practice Address - Phone:908-688-8800
Practice Address - Fax:908-688-2377
Is Sole Proprietor?:No
Enumeration Date:2007-10-22
Last Update Date:2014-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT182279207T00000X
NJ25MA08517100207T00000X
PAMD-433793207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0198838Medicaid
PA1023310500001Medicaid
PA1023310500001Medicaid
PA159974PAGMedicare PIN