Healthcare Provider Details

I. General information

NPI: 1912827262
Provider Name (Legal Business Name): RESTORE HEALTHCARE SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2026
Last Update Date: 07/17/2026
Certification Date: 07/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 VALLEY WAY
WEST ORANGE NJ
07052-5829
US

IV. Provider business mailing address

55 VALLEY WAY
WEST ORANGE NJ
07052-5829
US

V. Phone/Fax

Practice location:
  • Phone: 973-444-5579
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: LAMERCIE BRASIER
Title or Position: OWNER AUTHORIZED OFFICIAL
Credential:
Phone: 973-444-5579