Basic Information
| Provider Information | |||||||||
| NPI: | 1407874886 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RASTOGI | ||||||||
| FirstName: | VIJAY | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 185 ROSEBERRY ST | ||||||||
| Address2: | FARLEY BLDG., 2ND FLOOR | ||||||||
| City: | PHILLIPSBURG | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 088652773 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9088472621 | ||||||||
| FaxNumber: | 9088473045 | ||||||||
| Practice Location | |||||||||
| Address1: | 755 MEMORIAL PKWY STE 105 | ||||||||
| Address2: | |||||||||
| City: | PHILLIPSBURG | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 088652774 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4845262200 | ||||||||
| FaxNumber: | 4845262220 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/17/2006 | ||||||||
| LastUpdateDate: | 02/08/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | MD418637 | PA | N | Other Service Providers | Specialist | 208600000X | MD418637 | PA | N | Allopathic & Osteopathic Physicians | Surgery | 174400000X | MA75454 | NJ | Y | Other Service Providers | Specialist |
ID Information
| ID | Type | State | Issuer | Description | 0019089 | 05 | NJ | MEDICAID |