Organization
BROAD STREET MEDICAL, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
AMRISH PATEL (MD)
(862) 754-8233
Entity
Organization
Contact information
Practice address
1186 RAYMOND BLVD, 2ND FLOOR, NEWARK, NJ 07102-4108
(862) 754-8233
Mailing address
1186 RAYMOND BLVD, 2ND FLOOR, NEWARK, NJ 07102-4108
(862) 754-8233
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
—
—
208VP0000X
Pain Medicine Physician
Primary
—
—
Other
Enumeration date
05/03/2016
Last updated
05/03/2016
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