Provider Demographics
NPI:1679589121
Name:RUSTGI, VINOD KUMAR (MD)
Entity Type:Individual
Prefix:DR
First Name:VINOD
Middle Name:KUMAR
Last Name:RUSTGI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:66 W GILBERT ST FL 2
Mailing Address - Street 2:
Mailing Address - City:TINTON FALLS
Mailing Address - State:NJ
Mailing Address - Zip Code:07701-4947
Mailing Address - Country:US
Mailing Address - Phone:201-759-6921
Mailing Address - Fax:732-212-0713
Practice Address - Street 1:125 PATERSON ST STE 5100
Practice Address - Street 2:
Practice Address - City:NEW BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08901-1962
Practice Address - Country:US
Practice Address - Phone:732-235-7784
Practice Address - Fax:732-235-7792
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2021-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD-029154E207RG0100X
NJ25MA09823400207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA223602OtherANTHEM
DC43780001OtherBCBS
100012180OtherRAILROAD MEDICARE
VAB09574Medicare UPIN
00B190M91Medicare PIN