Provider Demographics
NPI:1174552806
Name:RUSTAGI, ANJU (MD)
Entity type:Individual
Prefix:
First Name:ANJU
Middle Name:
Last Name:RUSTAGI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 OLD CAMPLAIN RD STE 2H
Mailing Address - Street 2:
Mailing Address - City:HILLSBOROUGH
Mailing Address - State:NJ
Mailing Address - Zip Code:08844-4394
Mailing Address - Country:US
Mailing Address - Phone:908-429-7799
Mailing Address - Fax:866-611-9616
Practice Address - Street 1:120 OLD CAMPLAIN RD STE 2H
Practice Address - Street 2:
Practice Address - City:HILLSBOROUGH
Practice Address - State:NJ
Practice Address - Zip Code:08844-4394
Practice Address - Country:US
Practice Address - Phone:908-429-7799
Practice Address - Fax:866-611-9616
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2022-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA06830200208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8469806Medicaid
NJH31011Medicare UPIN
NJ045139QDWMedicare PIN