Provider Demographics
NPI:1073641429
Name:DIABETES & ENDOCRINOLOGY ASSOCIATES OF SOUTH JERSEY PC
Entity Type:Organization
Organization Name:DIABETES & ENDOCRINOLOGY ASSOCIATES OF SOUTH JERSEY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RISHI
Authorized Official - Middle Name:K
Authorized Official - Last Name:RASTOGI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:856-262-4681
Mailing Address - Street 1:512 STOCKTON DR
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08094-1984
Mailing Address - Country:US
Mailing Address - Phone:856-262-4681
Mailing Address - Fax:856-262-2376
Practice Address - Street 1:8 N WHITE HORSE PIKE STE 101
Practice Address - Street 2:
Practice Address - City:HAMMONTON
Practice Address - State:NJ
Practice Address - Zip Code:08037-1873
Practice Address - Country:US
Practice Address - Phone:609-704-9100
Practice Address - Fax:609-567-3817
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA05897300207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7520301Medicaid
NJ7520301Medicaid
NJ080020Medicare ID - Type Unspecified