Healthcare Provider Details

I. General information

NPI: 1144952029
Provider Name (Legal Business Name): OSTEOPATHIC REHAB ASSOCIATES PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/29/2022
Last Update Date: 11/18/2022
Certification Date: 11/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

282 SAINT PAULS AVE
JERSEY CITY NJ
07306-5085
US

IV. Provider business mailing address

282 SAINT PAULS AVE
JERSEY CITY NJ
07306-5085
US

V. Phone/Fax

Practice location:
  • Phone: 201-422-2556
  • Fax: 866-265-3540
Mailing address:
  • Phone: 201-422-2556
  • Fax: 866-265-3540

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. MANISH B PATEL
Title or Position: CEO/MEDICAL DIRECTOR
Credential: DO
Phone: 551-655-0953