Broad Street Medical, Inc

Primary specialty

Pain Medicine PhysicianTaxonomy code 208VP0000X

Legal business name

BROAD STREET MEDICAL, INC

Practice address

1186 Raymond Blvd
2ND Floor
Newark, NJ 07102-4108

Phone

(862) 754-8233

NPI assigned

May 3, 2016

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Amrish Patel

Title

MD

Phone

(862) 754-8233

Specialties & licenses 2

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1462233600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1462233600000",
    "number": "1881049377",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1186 RAYMOND BLVD",
            "address_2": "2ND FLOOR",
            "city": "NEWARK",
            "state": "NJ",
            "postal_code": "071024108",
            "telephone_number": "862-754-8233"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1186 RAYMOND BLVD",
            "address_2": "2ND FLOOR",
            "city": "NEWARK",
            "state": "NJ",
            "postal_code": "071024108",
            "telephone_number": "862-754-8233"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BROAD STREET MEDICAL, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-05-03",
        "last_updated": "2016-05-03",
        "status": "A",
        "authorized_official_last_name": "PATEL",
        "authorized_official_first_name": "AMRISH",
        "authorized_official_title_or_position": "MD",
        "authorized_official_telephone_number": "862-754-8233"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Chiropractor",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208VP0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pain Medicine, Pain Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Leslie Brinson
• David S Briss, D.M.D., FRCDC
• Tonya S. Brissett, NURSE PRACTITIONER
• Kevin Brister, CADC
• Brittany Marie Therapy Services LLC
• Broadwat Adult Medical Day Care Center
• Broadway Dental Group, PC
• Broadway House for Continuing Care
• Broadway Oral Surgery LLC
• Broadway Vision Services Inc.

• Pain Medicine Physician in Newark, NJ
• Providers in Newark, NJ by specialty
• Pain Medicine Physician in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 3, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.