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General NPI Number Information
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NPI Number | 1902011869
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Entity Type | Organization
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Legal Business Name | DIABETES & ENDOCRINOLOGY ASSOCIATES OF SOUTH JERSEY
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Dates
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Enumeration Date | 05/14/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1676 E LANDIS AVE
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City | VINELAND
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State | NJ
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Zip | 08361-2943
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Country | US
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Telephone | 856-262-4681
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Fax | 856-262-2376
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Provider Business Mailing Address
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Address Line | 512 STOCKTON DR
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City | WILLIAMSTOWN
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State | NJ
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Zip | 08094-1984
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Country | US
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Telephone | 856-262-4681
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Fax | 856-262-2376
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Authorized Official
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Title or Position | PRESIDENT
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Name | RISHI K RASTOGI
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Credential | M.D.
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Telephone | 856-262-4681
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RE0101X
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Taxonomy Name | Endocrinology, Diabetes & Metabolism Physician
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License Number | MA058973
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License Number State | NJ
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