Healthcare Provider Details

I. General information

NPI: 1760483804
Provider Name (Legal Business Name): ROBERT A. RESTIFO D.O
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2005
Last Update Date: 11/29/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 SPRINGFIELD AVE SUITE 3A
SUMMIT NJ
07901-4055
US

IV. Provider business mailing address

PO BOX 416457
BOSTON MA
02241-6457
US

V. Phone/Fax

Practice location:
  • Phone: 908-934-0555
  • Fax: 908-934-0556
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number25MB04780000
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number25MB04780000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: