Healthcare Provider Details

I. General information

NPI: 1376105262
Provider Name (Legal Business Name): HEALTH AND RESTORATION CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/01/2019
Last Update Date: 11/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

548 THROGGS NECK EXPY
BRONX NY
10465-1717
US

IV. Provider business mailing address

548 THROGGS NECK EXPY
BRONX NY
10465-1717
US

V. Phone/Fax

Practice location:
  • Phone: 845-309-0037
  • Fax:
Mailing address:
  • Phone: 845-309-0037
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: SHAMAR WILLIAMS
Title or Position: DR
Credential: NMD
Phone: 845-309-0037