Provider Demographics
NPI:1740216126
Name:PROGRESSIVE PHYSICAL MEDICINE AND REHABILITATION
Entity Type:Organization
Organization Name:PROGRESSIVE PHYSICAL MEDICINE AND REHABILITATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NUNZIO
Authorized Official - Middle Name:
Authorized Official - Last Name:SAULLE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:516-746-2727
Mailing Address - Street 1:131 JERICHO TPKE
Mailing Address - Street 2:SUITE A
Mailing Address - City:MINEOLA
Mailing Address - State:NY
Mailing Address - Zip Code:11501-1800
Mailing Address - Country:US
Mailing Address - Phone:516-746-2727
Mailing Address - Fax:516-746-2745
Practice Address - Street 1:131 JERICHO TPKE
Practice Address - Street 2:SUITE A
Practice Address - City:MINEOLA
Practice Address - State:NY
Practice Address - Zip Code:11501-1800
Practice Address - Country:US
Practice Address - Phone:516-746-2727
Practice Address - Fax:516-746-2745
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-25
Last Update Date:2007-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYG22907Medicare UPIN
NYWJ5041Medicare ID - Type Unspecified