Provider Demographics
NPI:1750344362
Name:LARGOZA, ROSENDITO S (MD)
Entity type:Individual
Prefix:
First Name:ROSENDITO
Middle Name:S
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 1:741 TEANECK RD
Mailing Address - Street 2:
Mailing Address - City:TEANECK
Mailing Address - State:NJ
Mailing Address - Zip Code:07666-4243
Mailing Address - Country:US
Mailing Address - Phone:201-862-0050
Mailing Address - Fax:201-862-0051
Practice Address - Street 1:741 TEANECK RD
Practice Address - Street 2:
Practice Address - City:TEANECK
Practice Address - State:NJ
Practice Address - Zip Code:07666
Practice Address - Country:US
Practice Address - Phone:201-862-0050
Practice Address - Fax:201-862-0051
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-07
Last Update Date:2010-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA04306500207P00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2499606Medicaid
NJ453002Medicare ID - Type Unspecified
NJ2499606Medicaid
NJ453002D45Medicare ID - Type Unspecified