Provider Demographics
NPI:1861574675
Name:P'BURG SURGICAL PROFESSIONAL ASSOCIATION
Entity type:Organization
Organization Name:P'BURG SURGICAL PROFESSIONAL ASSOCIATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:VIJAY
Authorized Official - Middle Name:
Authorized Official - Last Name:RASTOGI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:908-454-6711
Mailing Address - Street 1:755 MEMORIAL PKWY
Mailing Address - Street 2:SUITE 208
Mailing Address - City:PHILLIPSBURG
Mailing Address - State:NJ
Mailing Address - Zip Code:08865-2748
Mailing Address - Country:US
Mailing Address - Phone:908-454-6711
Mailing Address - Fax:908-454-6447
Practice Address - Street 1:755 MEMORIAL PKWY
Practice Address - Street 2:SUITE 208
Practice Address - City:PHILLIPSBURG
Practice Address - State:NJ
Practice Address - Zip Code:08865-2748
Practice Address - Country:US
Practice Address - Phone:908-454-6711
Practice Address - Fax:908-454-6447
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0019071Medicaid
NJ073899Medicare ID - Type Unspecified
NJ0019071Medicaid
PA076849Medicare ID - Type Unspecified
C53648Medicare UPIN