Provider Demographics
NPI:1043465289
Name:PROGRESSIVE MEDICAL ASSOCIATES, P.C
Entity Type:Organization
Organization Name:PROGRESSIVE MEDICAL ASSOCIATES, P.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:BOLON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-734-8877
Mailing Address - Street 1:161 MADISON AVE
Mailing Address - Street 2:7SE
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-5421
Mailing Address - Country:US
Mailing Address - Phone:212-734-8877
Mailing Address - Fax:212-734-2366
Practice Address - Street 1:90 E END AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10028-8000
Practice Address - Country:US
Practice Address - Phone:212-734-8877
Practice Address - Fax:212-734-2366
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-01
Last Update Date:2008-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes173000000XOther Service ProvidersLegal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYWJ7021Medicare PIN