Provider Demographics
NPI:1588436265
Name:RESTORE ARK HEALTHCARE LLC
Entity type:Organization
Organization Name:RESTORE ARK HEALTHCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:APN
Authorized Official - Prefix:
Authorized Official - First Name:OYEBOLA
Authorized Official - Middle Name:
Authorized Official - Last Name:ASENUGA
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP
Authorized Official - Phone:201-354-7112
Mailing Address - Street 1:108 WATCHUNG AVE # 1006
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07060-1251
Mailing Address - Country:US
Mailing Address - Phone:201-354-7112
Mailing Address - Fax:973-833-1466
Practice Address - Street 1:108 WATCHUNG AVE # 1006
Practice Address - Street 2:
Practice Address - City:PLAINFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07060-1251
Practice Address - Country:US
Practice Address - Phone:201-354-7112
Practice Address - Fax:973-833-1466
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-25
Last Update Date:2024-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty