Provider Demographics
NPI:1326354267
Name:CARL RESTIVO JR., M.D., PA
Entity Type:Organization
Organization Name:CARL RESTIVO JR., M.D., PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CARL
Authorized Official - Middle Name:
Authorized Official - Last Name:RESTIVO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-798-2900
Mailing Address - Street 1:3 WEBSTER AVE
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07307-1866
Mailing Address - Country:US
Mailing Address - Phone:201-798-2900
Mailing Address - Fax:201-798-3582
Practice Address - Street 1:3 WEBSTER AVE
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07307-1866
Practice Address - Country:US
Practice Address - Phone:201-798-2900
Practice Address - Fax:201-798-3582
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-30
Last Update Date:2010-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA03328700207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1245217751OtherNPI, PERSONAL
NJ44466385JMedicaid
C56204Medicare UPIN
NJ44466385JMedicaid