Provider Demographics
NPI:1659905313
Name:RESTART HEALTH AND WELLNESS LLC
Entity Type:Organization
Organization Name:RESTART HEALTH AND WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MOHAMED
Authorized Official - Middle Name:
Authorized Official - Last Name:ELSAMRA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:203-887-3890
Mailing Address - Street 1:19 ELLIS RD
Mailing Address - Street 2:
Mailing Address - City:EAST HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06512-4627
Mailing Address - Country:US
Mailing Address - Phone:203-888-3890
Mailing Address - Fax:844-833-5610
Practice Address - Street 1:1336 W MAIN ST STE 2A
Practice Address - Street 2:
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06708-3122
Practice Address - Country:US
Practice Address - Phone:203-887-3890
Practice Address - Fax:844-833-5610
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-02
Last Update Date:2020-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty