MEDICARE: RESTORE HEALTH AND WELLNESS CENTER NEW JERSEY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QR0405X	Substance Use Disorder Rehabilitation Clinic/Center

General Provider Information

NPI Number	:	1639021587
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RESTORE HEALTH AND WELLNESS CENTER NEW JERSEY

Provider Business Mailing Address
First Line	:	486 STATE ROUTE 10
Second Line	:
City	:	RANDOLPH
State	:	NJ
Zip	:	07869-2133
Country	:	US
Telephone Number	:	954-641-5366
Fax Number	:

Provider Business Practice Location Address
First Line	:	486 STATE ROUTE 10
Second Line	:
City	:	RANDOLPH
State	:	NJ
Zip	:	07869-2133
Country	:	US
Telephone Number	:	954-641-5366
Fax Number	:

Authorized Official
Title or Position	:	COO
Name	:	ERIC LEON
Credential	:
Telephone Number	:	954-641-5366

Provider Enumeration Date	:	02/12/2026
Last Update Date	:	02/12/2026

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