Provider Demographics
NPI:1609919588
Name:RUSTGI, ANIL K (MD)
Entity type:Individual
Prefix:
First Name:ANIL
Middle Name:K
Last Name:RUSTGI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1130 SAINT NICHOLAS AVE RM 201
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10032-3802
Mailing Address - Country:US
Mailing Address - Phone:212-851-4822
Mailing Address - Fax:212-851-4660
Practice Address - Street 1:1130 SAINT NICHOLAS AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10032-3802
Practice Address - Country:US
Practice Address - Phone:212-851-4822
Practice Address - Fax:212-851-4660
Is Sole Proprietor?:No
Enumeration Date:2007-02-14
Last Update Date:2024-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD066015L207R00000X, 207RG0100X
NY299613207R00000X, 207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0017074250001Medicaid
PA0017074250001Medicaid
PAE58866Medicare UPIN
PA014745Medicare PIN