Healthcare Provider Details

I. General information

NPI: 1477180974
Provider Name (Legal Business Name): JUSTIN RASHTIAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/25/2020
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

209 W 19TH ST
NEW YORK NY
10011-4001
US

IV. Provider business mailing address

55 E 87TH ST STE 1C
NEW YORK NY
10128-1049
US

V. Phone/Fax

Practice location:
  • Phone: 212-686-6321
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number337437
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License NumberTL.0009915
License Number StateCO
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberTL.0009915
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: