Provider Demographics
NPI:1326477985
Name:PROGRESSIVE PAIN MANAGEMENT LLC
Entity Type:Organization
Organization Name:PROGRESSIVE PAIN MANAGEMENT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:ALWIN
Authorized Official - Last Name:BANNISTER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:347-424-6157
Mailing Address - Street 1:802 W PARK AVE STE 223
Mailing Address - Street 2:
Mailing Address - City:OCEAN
Mailing Address - State:NJ
Mailing Address - Zip Code:07712-8526
Mailing Address - Country:US
Mailing Address - Phone:732-493-2040
Mailing Address - Fax:732-493-4582
Practice Address - Street 1:802 W PARK AVE STE 223
Practice Address - Street 2:
Practice Address - City:OCEAN
Practice Address - State:NJ
Practice Address - Zip Code:07712-8526
Practice Address - Country:US
Practice Address - Phone:732-493-2040
Practice Address - Fax:732-493-4582
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-04
Last Update Date:2021-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA08847600207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty