Provider Demographics
NPI:1821122888
Name:RASTOGI, RAJENDRA C (DDS)
Entity Type:Individual
Prefix:DR
First Name:RAJENDRA
Middle Name:C
Last Name:RASTOGI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:780 DECKER PL
Mailing Address - Street 2:
Mailing Address - City:PARAMUS
Mailing Address - State:NJ
Mailing Address - Zip Code:07652-3709
Mailing Address - Country:US
Mailing Address - Phone:201-652-1575
Mailing Address - Fax:718-561-6126
Practice Address - Street 1:103 E BURNSIDE AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10453-4142
Practice Address - Country:US
Practice Address - Phone:718-367-1113
Practice Address - Fax:718-561-6126
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0305241223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00286291Medicaid