Provider Demographics
NPI:1669840096
Name:PROGRESSIVE PEDIATRIC ENDOCRINE
Entity Type:Organization
Organization Name:PROGRESSIVE PEDIATRIC ENDOCRINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PEDIATRIC ENDOCRINOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:B
Authorized Official - Last Name:LEVINE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-942-6538
Mailing Address - Street 1:90 PROSPECT AVE
Mailing Address - Street 2:
Mailing Address - City:HACKENSACK
Mailing Address - State:NJ
Mailing Address - Zip Code:07601-1909
Mailing Address - Country:US
Mailing Address - Phone:201-342-6538
Mailing Address - Fax:201-342-9569
Practice Address - Street 1:90 PROSPECT AVE
Practice Address - Street 2:
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07601-1909
Practice Address - Country:US
Practice Address - Phone:201-342-6538
Practice Address - Fax:201-342-9569
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-02
Last Update Date:2015-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA060775002080P0205X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080P0205XAllopathic & Osteopathic PhysiciansPediatricsPediatric EndocrinologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJB54348Medicare UPIN