Provider Demographics
NPI:1346356185
Name:RASTOGI, PUNEET (OD)
Entity Type:Individual
Prefix:DR
First Name:PUNEET
Middle Name:
Last Name:RASTOGI
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2033-65 ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11204
Mailing Address - Country:US
Mailing Address - Phone:312-925-9519
Mailing Address - Fax:
Practice Address - Street 1:1010 2ND AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10022-4966
Practice Address - Country:US
Practice Address - Phone:212-753-7733
Practice Address - Fax:212-753-2677
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-22
Last Update Date:2011-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ27OA006059000152W00000X
NY007067152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY002930341OtherUHC
NYG400010849OtherMEDICARE PC PTAN
NYP3704908OtherOXFORD
NYG400010849OtherMEDICARE PC PTAN
NYP3704908OtherOXFORD