MEDICARE: DR. PAWAN RASTOGI M.D

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	207R00000X	Internal Medicine Physician	299546	NY
2	390200000X	Student in an Organized Health Care Education/Training Program
3	207RG0100X	Gastroenterology Physician	299546	NY

General Provider Information

NPI Number	:	1972947885
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PAWAN RASTOGI M.D

Provider Business Mailing Address
First Line	:	2649 STRANG BLVD STE 206
Second Line	:
City	:	YORKTOWN HTS
State	:	NY
Zip	:	10598-2938
Country	:	US
Telephone Number	:	914-233-3008
Fax Number	:	914-233-3011

Provider Business Practice Location Address
First Line	:	2649 STRANG BLVD STE 206
Second Line	:
City	:	YORKTOWN HTS
State	:	NY
Zip	:	10598-2938
Country	:	US
Telephone Number	:	914-233-3008
Fax Number	:	914-233-3011

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

Provider Enumeration Date	:	04/22/2013
Last Update Date	:	12/28/2022

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