Provider Demographics
NPI:1245404003
Name:PROGRESSIVE CARDIOVASCULAR CARE P.C.
Entity Type:Organization
Organization Name:PROGRESSIVE CARDIOVASCULAR CARE P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:M.D.
Authorized Official - Prefix:
Authorized Official - First Name:RAKESH
Authorized Official - Middle Name:P
Authorized Official - Last Name:GUPTA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:631-940-1120
Mailing Address - Street 1:9033 SPRINGFIELD BLVD
Mailing Address - Street 2:
Mailing Address - City:QUEENS VILLAGE
Mailing Address - State:NY
Mailing Address - Zip Code:11428-1352
Mailing Address - Country:US
Mailing Address - Phone:718-464-5225
Mailing Address - Fax:718-740-8838
Practice Address - Street 1:9033 SPRINGFIELD BLVD
Practice Address - Street 2:
Practice Address - City:QUEENS VILLAGE
Practice Address - State:NY
Practice Address - Zip Code:11428-1352
Practice Address - Country:US
Practice Address - Phone:718-464-5225
Practice Address - Fax:718-740-8838
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-14
Last Update Date:2008-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional CardiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02880651Medicaid
NY08098OtherGHI MEDICARE
NY08098OtherGHI MEDICARE