Provider Demographics
NPI:1326014747
Name:LARGOZA, RODRIGO T (MD)
Entity Type:Individual
Prefix:
First Name:RODRIGO
Middle Name:T
Last Name:LARGOZA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 51020
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07101-5120
Mailing Address - Country:US
Mailing Address - Phone:201-945-2481
Mailing Address - Fax:201-943-8105
Practice Address - Street 1:308 WILLOW AVE
Practice Address - Street 2:
Practice Address - City:HOBOKEN
Practice Address - State:NJ
Practice Address - Zip Code:07030-3808
Practice Address - Country:US
Practice Address - Phone:201-945-2481
Practice Address - Fax:201-943-8105
Is Sole Proprietor?:No
Enumeration Date:2006-02-25
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA02776600207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJE89639Medicaid
NJE89639Medicare UPIN
NJE89639Medicaid