Provider Demographics
NPI:1821536194
Name:IRESTORE
Entity Type:Organization
Organization Name:IRESTORE
Other - Org Name:REHAB PARTNER
Other - Org Type:Other Name
Authorized Official - Title/Position:FOUNDER
Authorized Official - Prefix:
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:CRAIG
Authorized Official - Last Name:LEFKOWITZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:747-222-6505
Mailing Address - Street 1:PO BOX 391
Mailing Address - Street 2:
Mailing Address - City:AGOURA
Mailing Address - State:CA
Mailing Address - Zip Code:91376-0391
Mailing Address - Country:US
Mailing Address - Phone:747-222-6505
Mailing Address - Fax:800-662-1773
Practice Address - Street 1:23945 CALABASAS RD
Practice Address - Street 2:
Practice Address - City:CALABASAS
Practice Address - State:CA
Practice Address - Zip Code:91302-1552
Practice Address - Country:US
Practice Address - Phone:747-222-6505
Practice Address - Fax:800-662-1773
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-07
Last Update Date:2017-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain