Healthcare Provider Details

I. General information

NPI: 1184550154
Provider Name (Legal Business Name): RESTORE NYC, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/18/2026
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16 W 36TH ST RM 602
NEW YORK NY
10018-9764
US

IV. Provider business mailing address

16 W 36TH ST RM 602
NEW YORK NY
10018-9764
US

V. Phone/Fax

Practice location:
  • Phone: 212-840-8484
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: GABRIELLE MASIH
Title or Position: CLINICAL DIRECTOR
Credential: LCSW
Phone: 332-600-1234