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General NPI Number Information
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NPI Number | 1215109848
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Entity Type | Organization
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Legal Business Name | RUSTOM A RASTINEHAD PC
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Dates
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Enumeration Date | 03/24/2008
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Last Update Date | 07/02/2008
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Provider Practice Location Address
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Address Line | 271 W CIRCULAR ST
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City | SARATOGA SPRINGS
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State | NY
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Zip | 12866-6012
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Country | US
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Telephone | 518-587-8421
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Fax | 518-587-8423
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Provider Business Mailing Address
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Address Line | 271 W CIRCULAR ST
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City | SARATOGA SPRINGS
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State | NY
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Zip | 12866-6012
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Country | US
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Telephone | 518-587-8421
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Fax | 518-587-8423
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Authorized Official
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Title or Position | PRESIDENT
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Name | RUSTOM ARDESHIR RASTINEHAD
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Credential | M.D.
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Telephone | 518-587-8421
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208800000X
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Taxonomy Name | Urology Physician
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License Number | 1137281
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License Number State | NY
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