Provider Demographics
NPI:1144583519
Name:ST REMI LLC
Entity Type:Organization
Organization Name:ST REMI LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/ MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ISIAKA
Authorized Official - Middle Name:ABAYOMI
Authorized Official - Last Name:BOLARINWA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:856-282-5566
Mailing Address - Street 1:822 KLEMM AVE
Mailing Address - Street 2:
Mailing Address - City:GLOUCESTER CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:08030-1627
Mailing Address - Country:US
Mailing Address - Phone:856-282-5566
Mailing Address - Fax:856-885-4471
Practice Address - Street 1:822 KLEMM AVE
Practice Address - Street 2:
Practice Address - City:GLOUCESTER CITY
Practice Address - State:NJ
Practice Address - Zip Code:08030-1627
Practice Address - Country:US
Practice Address - Phone:856-282-5566
Practice Address - Fax:856-396-9917
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LBN
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-06-20
Last Update Date:2023-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA0726972084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent PsychiatryGroup - Single Specialty