Provider Demographics
NPI:1801222476
Name:PROGRESSIVE SPINE & ORTHOPAEDICS, LLC
Entity Type:Organization
Organization Name:PROGRESSIVE SPINE & ORTHOPAEDICS, LLC
Other - Org Name:NJ DISC CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:LUZ
Authorized Official - Middle Name:
Authorized Official - Last Name:RIOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-581-7010
Mailing Address - Street 1:477 BRACE AVE
Mailing Address - Street 2:
Mailing Address - City:PERTH AMBOY
Mailing Address - State:NJ
Mailing Address - Zip Code:08861-3018
Mailing Address - Country:US
Mailing Address - Phone:732-442-0969
Mailing Address - Fax:
Practice Address - Street 1:477 BRACE AVE STE 1
Practice Address - Street 2:
Practice Address - City:PERTH AMBOY
Practice Address - State:NJ
Practice Address - Zip Code:08861-3018
Practice Address - Country:US
Practice Address - Phone:732-442-0969
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-16
Last Update Date:2023-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty