MEDICARE: DR. RAJENDRA C RASTOGI DDS

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	030524	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1821122888
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RAJENDRA C RASTOGI DDS

Provider Business Mailing Address
First Line	:	780 DECKER PL
Second Line	:
City	:	PARAMUS
State	:	NJ
Zip	:	07652-3709
Country	:	US
Telephone Number	:	201-652-1575
Fax Number	:	718-561-6126

Provider Business Practice Location Address
First Line	:	103 E BURNSIDE AVE
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10453-4142
Country	:	US
Telephone Number	:	718-367-1113
Fax Number	:	718-561-6126

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

Provider Enumeration Date	:	03/14/2007
Last Update Date	:	07/08/2007

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