Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0300X | Geriatric Medicine | 25MA06684500 | NJ |
NPI | 1073501094 |
---|---|
Provider Name | Dr. Sarita Rastogi |
First Address | Mahwah, NJ 07430-3862 |
Second Address | Hackensack, NJ 07601-1310 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/10/2005 |
Last Update Date | 15/06/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
DG2892 | RAILROAD MEDICARE (01) | NJ |
G80132 | (02) |