Provider Demographics
NPI:1215109848
Name:RUSTOM A RASTINEHAD PC
Entity type:Organization
Organization Name:RUSTOM A RASTINEHAD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RUSTOM
Authorized Official - Middle Name:ARDESHIR
Authorized Official - Last Name:RASTINEHAD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:518-587-8421
Mailing Address - Street 1:271 W CIRCULAR ST
Mailing Address - Street 2:
Mailing Address - City:SARATOGA SPRINGS
Mailing Address - State:NY
Mailing Address - Zip Code:12866-6012
Mailing Address - Country:US
Mailing Address - Phone:518-587-8421
Mailing Address - Fax:518-587-8423
Practice Address - Street 1:271 W CIRCULAR ST
Practice Address - Street 2:
Practice Address - City:SARATOGA SPRINGS
Practice Address - State:NY
Practice Address - Zip Code:12866-6012
Practice Address - Country:US
Practice Address - Phone:518-587-8421
Practice Address - Fax:518-587-8423
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-24
Last Update Date:2008-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1137281208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY000405240001OtherBLUE SHIELD
NY00376178Medicaid
NY24108OtherMVP
NY46319OtherGHI
NY95117OtherEMP. BLUE CROSS
NYB80879Medicare UPIN
NYBA1386Medicare PIN
NY337300BMedicare PIN