Healthcare Provider Details

I. General information

NPI: 1326186487
Provider Name (Legal Business Name): SARITA RASTOGI MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/01/2007
Last Update Date: 08/22/2020
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 Number
License Number State

VII. Legacy identifiers

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

VIII. Authorized Official

Name: SARITA RASTOGI
Title or Position: DIRECTOR
Credential: M.D.
Phone: 201-489-8567