Provider Demographics
NPI:1326602673
Name:JUTA, RASNA (MD)
Entity type:Individual
Prefix:DR
First Name:RASNA
Middle Name:
Last Name:JUTA
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2201 HEMPSTEAD TURNPIKE
Mailing Address - Street 2:
Mailing Address - City:EAST MEADOW
Mailing Address - State:NY
Mailing Address - Zip Code:11554
Mailing Address - Country:US
Mailing Address - Phone:516-572-5034
Mailing Address - Fax:
Practice Address - Street 1:222 STATION PLZ N STE 400
Practice Address - Street 2:
Practice Address - City:MINEOLA
Practice Address - State:NY
Practice Address - Zip Code:11501-3893
Practice Address - Country:US
Practice Address - Phone:516-663-2507
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-23
Last Update Date:2025-04-14
Deactivation Date:2019-12-16
Deactivation Code:
Reactivation Date:2020-09-29
Provider Licenses
StateLicense IDTaxonomies
390200000X
NY324061207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program