Provider Demographics
NPI:1932681848
Name:SIXTH BOROUGH MEDICAL LLC
Entity Type:Organization
Organization Name:SIXTH BOROUGH MEDICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:MANISH
Authorized Official - Middle Name:B
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:201-422-2556
Mailing Address - Street 1:282 ST PAULS AVENUE
Mailing Address - Street 2:FLOOR 1
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07306-5085
Mailing Address - Country:US
Mailing Address - Phone:201-422-2556
Mailing Address - Fax:866-265-3540
Practice Address - Street 1:282 ST PAULS AVENUE
Practice Address - Street 2:FLOOR 1
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07306-5085
Practice Address - Country:US
Practice Address - Phone:201-422-2556
Practice Address - Fax:866-265-3540
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-06
Last Update Date:2023-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB09801400208100000X
208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0450747054OtherNJ DEPARTMENT OF THE TREASURY