Provider Demographics
NPI:1457477093
Name:DIABETES & ENDOCRINOLOGY ASSOCITES OF SOUTH JERSEY
Entity Type:Organization
Organization Name:DIABETES & ENDOCRINOLOGY ASSOCITES OF SOUTH JERSEY
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 1:2815 E CHESTNUT AVE
Practice Address - Street 2:
Practice Address - City:VINELAND
Practice Address - State:NJ
Practice Address - Zip Code:08361-8466
Practice Address - Country:US
Practice Address - Phone:856-262-4681
Practice Address - Fax:856-262-2376
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7520301Medicaid
NJG37354Medicare UPIN
NJ7520301Medicaid