MEDICARE: SHANTANU RASTOGI MD

Medicare Provider Information

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2080N0001X	Neonatal-Perinatal Medicine Physician	249490	NY

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0100130-03	OTHER	NY	AMERICHOICE
2	2050698	OTHER	NY	UNITED HEALTHCARE
3	2603108	OTHER	NY	GHI
4	113542361	OTHER	NY	HORIZON HEALTHCARE NY
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	000969	OTHER	NY	HIP
7	P2171926	OTHER	NY	OXFORD HEALTH PLAN
8	RS0969	OTHER	NY	ATLANTIS HEALTH
9	1000029918	OTHER	NY	AFFINITY HEALTH
10	343640201	OTHER	NY	HEALTH PLUS
11	000969-A15	OTHER	NY	HEALTH FIRST
12	4C4443	OTHER	NY	HEALTH NET

NPI Number	:	1235124991
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHANTANU RASTOGI MD

Provider Business Mailing Address
First Line	:	1825 EASTCHESTER RD
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10461-2301
Country	:	US
Telephone Number	:	718-904-4105
Fax Number	:

Provider Business Practice Location Address
First Line	:	1825 EASTCHESTER RD
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10461-2301
Country	:	US
Telephone Number	:	718-904-4105
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/19/2005
Last Update Date	:	12/30/2025

7500 SECURITY BOULEVARD , CENTERS FOR MEDICARE & MEDICAID SERVICES
BALTIMORE, MD
21201-2301

Practice Phone: 410-786-6614
Practice Fax: