Provider Demographics
NPI:1194394825
Name:RESTORATIVE PSYCH LLC
Entity Type:Organization
Organization Name:RESTORATIVE PSYCH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:NJOROGE
Authorized Official - Last Name:KIMANI
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:908-205-8973
Mailing Address - Street 1:123 LEXINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH PLAINFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07080-2610
Mailing Address - Country:US
Mailing Address - Phone:732-322-1807
Mailing Address - Fax:
Practice Address - Street 1:123 LEXINGTON AVE
Practice Address - Street 2:
Practice Address - City:SOUTH PLAINFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07080-2610
Practice Address - Country:US
Practice Address - Phone:732-322-1807
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-17
Last Update Date:2021-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty