Provider Demographics
NPI:1871863837
Name:PROGRESSIVE SPINE & ORTHOPAEDICS, LLC
Entity Type:Organization
Organization Name:PROGRESSIVE SPINE & ORTHOPAEDICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:SETH
Authorized Official - Last Name:ROVNER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-227-1299
Mailing Address - Street 1:440 CURRY AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:ENGLEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07631-6704
Mailing Address - Country:US
Mailing Address - Phone:201-227-1299
Mailing Address - Fax:201-569-1987
Practice Address - Street 1:440 CURRY AVE
Practice Address - Street 2:SUITE A
Practice Address - City:ENGLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07631-6704
Practice Address - Country:US
Practice Address - Phone:201-227-1299
Practice Address - Fax:201-569-1987
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-09
Last Update Date:2012-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA08410000207XS0117X, 207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the SpineGroup - Multi-Specialty
No207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports MedicineGroup - Multi-Specialty