Provider Demographics
NPI:1891344057
Name:PROGRESSIVE PHYSIATRY
Entity Type:Organization
Organization Name:PROGRESSIVE PHYSIATRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:FERGIE-ROSS
Authorized Official - Middle Name:
Authorized Official - Last Name:MONTERO-CRUZ
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:201-227-1299
Mailing Address - Street 1:3 PROGRESS ST STE 102
Mailing Address - Street 2:
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08820-1180
Mailing Address - Country:US
Mailing Address - Phone:201-227-1299
Mailing Address - Fax:201-227-0077
Practice Address - Street 1:3 PROGRESS ST STE 102
Practice Address - Street 2:
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08820-1180
Practice Address - Country:US
Practice Address - Phone:201-227-1299
Practice Address - Fax:201-227-0077
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-10
Last Update Date:2019-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty