| Broadstreet Healthcare Inc | |
|
395 Danforth Ave Jersey City NJ 07305-1975 | |
| (201) 332-4600 | |
| (201) 332-4670 |
| Full Name | Broadstreet Healthcare Inc |
|---|---|
| Speciality | Internal Medicine |
| Location | 395 Danforth Ave, Jersey City, New Jersey |
| Authorized Official Name and Position | Parvez Alam (OWNER) |
| Authorized Official Contact | 2013324600 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Broadstreet Healthcare Inc 395 Danforth Ave Jersey City NJ 07305-1975 Ph: (201) 332-4600 | Broadstreet Healthcare Inc 395 Danforth Ave Jersey City NJ 07305-1975 Ph: (201) 332-4600 |
| NPI Number | 1306337209 |
|---|---|
| Provider Enumeration Date | 05/25/2018 |
| Last Update Date | 05/25/2018 |
| Medicare PECOS PAC ID | 4789924986 |
|---|---|
| Medicare Enrollment ID | O20190326002238 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1306337209 | NPI | - | NPPES |
| 7807406 | Medicaid | NJ |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | 25MA06755300 (New Jersey) | Primary |
| Provider Name | Parvez Alam |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1740397181 PECOS PAC ID: 7214993039 Enrollment ID: I20041203000368 |
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