Provider Demographics
NPI:1407874886
Name:RASTOGI, VIJAY (MD)
Entity Type:Individual
Prefix:
First Name:VIJAY
Middle Name:
Last Name:RASTOGI
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 1:185 ROSEBERRY ST
Mailing Address - Street 2:FARLEY BLDG., 2ND FLOOR
Mailing Address - City:PHILLIPSBURG
Mailing Address - State:NJ
Mailing Address - Zip Code:08865-2773
Mailing Address - Country:US
Mailing Address - Phone:908-847-2621
Mailing Address - Fax:908-847-3045
Practice Address - Street 1:755 MEMORIAL PKWY STE 105
Practice Address - Street 2:
Practice Address - City:PHILLIPSBURG
Practice Address - State:NJ
Practice Address - Zip Code:08865-2774
Practice Address - Country:US
Practice Address - Phone:484-526-2200
Practice Address - Fax:484-526-2220
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2019-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD418637174400000X, 208600000X
NJMA75454174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0019089Medicaid
NJ0019089Medicaid
NJ071101R5MMedicare ID - Type Unspecified