Provider Demographics
NPI:1518026772
Name:RESTORE USA, INC.
Entity Type:Organization
Organization Name:RESTORE USA, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:
Authorized Official - Last Name:FREER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-860-4637
Mailing Address - Street 1:338A E 7TH ST APT A
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11218-4106
Mailing Address - Country:US
Mailing Address - Phone:917-685-8171
Mailing Address - Fax:718-434-1617
Practice Address - Street 1:4626 NEW UTRECHT AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11219-2553
Practice Address - Country:US
Practice Address - Phone:718-860-4637
Practice Address - Fax:718-434-1617
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-06
Last Update Date:2019-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02812031Medicaid
NY5594260001Medicare NSC