Provider Demographics
NPI:1013598150
Name:PROGRESSIVE SPINE & ORTHOPAEDICS, LLC
Entity Type:Organization
Organization Name:PROGRESSIVE SPINE & ORTHOPAEDICS, LLC
Other - Org Name:GLEN ROCK SPINE & REHAB
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:SETH
Authorized Official - Last Name:ROVNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-227-1299
Mailing Address - Street 1:208 HARRISTOWN RD LOWR LEVEL1
Mailing Address - Street 2:
Mailing Address - City:GLEN ROCK
Mailing Address - State:NJ
Mailing Address - Zip Code:07452-3308
Mailing Address - Country:US
Mailing Address - Phone:201-425-1560
Mailing Address - Fax:
Practice Address - Street 1:208 HARRISTOWN RD LOWR LEVEL1
Practice Address - Street 2:
Practice Address - City:GLEN ROCK
Practice Address - State:NJ
Practice Address - Zip Code:07452-3308
Practice Address - Country:US
Practice Address - Phone:201-425-1560
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PROGRESSIVE SPINE & ORTHOPAEDICS, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-04-20
Last Update Date:2021-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty