Provider Demographics
NPI:1942703814
Name:RESTORATION HEALTH, PLLC
Entity Type:Organization
Organization Name:RESTORATION HEALTH, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LIZ
Authorized Official - Middle Name:A
Authorized Official - Last Name:DOYLE-SANTINI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-239-3400
Mailing Address - Street 1:335 UPSON TER
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06512-3145
Mailing Address - Country:US
Mailing Address - Phone:203-722-6422
Mailing Address - Fax:
Practice Address - Street 1:12 VILLAGE ST STE 3
Practice Address - Street 2:
Practice Address - City:NORTH HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06473-3828
Practice Address - Country:US
Practice Address - Phone:203-239-3400
Practice Address - Fax:203-239-4900
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-16
Last Update Date:2018-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175F00000XOther Service ProvidersNaturopathGroup - Single Specialty