Provider Demographics
NPI:1073501094
Name:RASTOGI, SARITA (MD)
Entity Type:Individual
Prefix:DR
First Name:SARITA
Middle Name:
Last Name:RASTOGI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:160 STEPHENS LN
Mailing Address - Street 2:
Mailing Address - City:MAHWAH
Mailing Address - State:NJ
Mailing Address - Zip Code:07430-3862
Mailing Address - Country:US
Mailing Address - Phone:201-489-8567
Mailing Address - Fax:201-489-8565
Practice Address - Street 1:140 SUMMIT AVE
Practice Address - Street 2:
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07601-1310
Practice Address - Country:US
Practice Address - Phone:201-489-8567
Practice Address - Fax:201-489-8565
Is Sole Proprietor?:No
Enumeration Date:2005-10-13
Last Update Date:2014-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA06684500207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJDG2892OtherRAILROAD MEDICARE
RA012266Medicare ID - Type Unspecified
G80132Medicare UPIN