Healthcare Provider Details

I. General information

NPI: 1073501094
Provider Name (Legal Business Name): SARITA RASTOGI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/13/2005
Last Update Date: 06/15/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 SUMMIT AVE
HACKENSACK NJ
07601-1310
US

IV. Provider business mailing address

160 STEPHENS LN
MAHWAH NJ
07430-3862
US

V. Phone/Fax

Practice location:
  • Phone: 201-489-8567
  • Fax: 201-489-8565
Mailing address:
  • Phone: 201-489-8567
  • Fax: 201-489-8565

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number25MA06684500
License Number StateNJ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
IdentifierDG2892
Identifier TypeOTHER
Identifier StateNJ
Identifier IssuerRAILROAD MEDICARE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: