Healthcare Provider Details

I. General information

NPI: 1093628398
Provider Name (Legal Business Name): RESTORE MEDICAL GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2026
Last Update Date: 09/26/2026
Certification Date: 09/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

255 ROUTE 3 STE 105
SECAUCUS NJ
07094-3857
US

IV. Provider business mailing address

255 ROUTE 3 STE 105
SECAUCUS NJ
07094-3857
US

V. Phone/Fax

Practice location:
  • Phone: 201-735-1355
  • Fax: 201-735-2066
Mailing address:
  • Phone: 201-735-1355
  • Fax: 201-735-2066

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number State

VIII. Authorized Official

Name: DR. AHMAD BADRI
Title or Position: OWNER/FOUNDER
Credential: DO
Phone: 973-330-6161