MEDICARE: ST REMI LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0804X	Child & Adolescent Psychiatry Physician
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	MA072697	NJ
3	2084P0800X	Psychiatry Physician

General Provider Information

NPI Number	:	1144583519
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ST REMI LLC

Provider Business Mailing Address
First Line	:	822 KLEMM AVE
Second Line	:
City	:	GLOUCESTER CITY
State	:	NJ
Zip	:	08030-1627
Country	:	US
Telephone Number	:	856-282-5566
Fax Number	:	856-885-4471

Provider Business Practice Location Address
First Line	:	822 KLEMM AVE
Second Line	:
City	:	GLOUCESTER CITY
State	:	NJ
Zip	:	08030-1627
Country	:	US
Telephone Number	:	856-282-5566
Fax Number	:	856-396-9917

Authorized Official
Title or Position	:	PRESIDENT/ MEDICAL DIRECTOR
Name	:	ISIAKA A BOLARINWA
Credential	:
Telephone Number	:	856-282-5566

Provider Enumeration Date	:	06/20/2012
Last Update Date	:	02/04/2026

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Directions to “ST REMI LLC ” Practice Location

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