Provider Demographics
NPI:1801002456
Name:PROGRESSIVE DERMATOLOGY, P.C.
Entity Type:Organization
Organization Name:PROGRESSIVE DERMATOLOGY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:BETH
Authorized Official - Last Name:SEPTON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:516-712-9337
Mailing Address - Street 1:65 HICKORY RD # B
Mailing Address - Street 2:
Mailing Address - City:PORT WASHINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11050-1517
Mailing Address - Country:US
Mailing Address - Phone:516-712-9337
Mailing Address - Fax:516-294-4569
Practice Address - Street 1:65 HICKORY RD # B
Practice Address - Street 2:
Practice Address - City:PORT WASHINGTON
Practice Address - State:NY
Practice Address - Zip Code:11050-1517
Practice Address - Country:US
Practice Address - Phone:516-712-9337
Practice Address - Fax:516-294-4569
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY233325-1207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY3K5711Medicare ID - Type Unspecified
NYH35287Medicare UPIN