Provider Demographics
NPI:1932338514
Name:RASTINEHAD, ARDESHIR RUSTOM (DO)
Entity Type:Individual
Prefix:DR
First Name:ARDESHIR
Middle Name:RUSTOM
Last Name:RASTINEHAD
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:150 EAST 42ND STREET
Mailing Address - Street 2:10TH FLOOR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10017
Mailing Address - Country:US
Mailing Address - Phone:646-605-8119
Mailing Address - Fax:646-605-3031
Practice Address - Street 1:450 LAKEVILLE RD
Practice Address - Street 2:SUITE M41
Practice Address - City:NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11042-1118
Practice Address - Country:US
Practice Address - Phone:516-734-8500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-05
Last Update Date:2016-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY246701-12085R0204X, 208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
No2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology