MEDICARE: VIJAY RASTOGI M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	MD418637	PA
2	208600000X	Surgery Physician	MD418637	PA
3	174400000X	Specialist	MA75454	NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1407874886
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VIJAY RASTOGI M.D.

Provider Business Mailing Address
First Line	:	185 ROSEBERRY ST
Second Line	:	FARLEY BLDG., 2ND FLOOR
City	:	PHILLIPSBURG
State	:	NJ
Zip	:	08865-2773
Country	:	US
Telephone Number	:	908-847-2621
Fax Number	:	908-847-3045

Provider Business Practice Location Address
First Line	:	755 MEMORIAL PKWY STE 105
Second Line	:
City	:	PHILLIPSBURG
State	:	NJ
Zip	:	08865-2774
Country	:	US
Telephone Number	:	484-526-2200
Fax Number	:	484-526-2220

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/17/2006
Last Update Date	:	02/08/2019

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