Provider Demographics
NPI:1700186814
Name:PROGRESSIVE ARRHYTHMIA & CARDIAC CARE PLLC
Entity Type:Organization
Organization Name:PROGRESSIVE ARRHYTHMIA & CARDIAC CARE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING LAISON
Authorized Official - Prefix:MRS
Authorized Official - First Name:EILLEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTINEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-482-1355
Mailing Address - Street 1:1350 DEER PARK AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH BABYLON
Mailing Address - State:NY
Mailing Address - Zip Code:11703-1619
Mailing Address - Country:US
Mailing Address - Phone:631-482-1355
Mailing Address - Fax:631-482-1356
Practice Address - Street 1:1350 DEER PARK AVE
Practice Address - Street 2:
Practice Address - City:NORTH BABYLON
Practice Address - State:NY
Practice Address - Zip Code:11703-1619
Practice Address - Country:US
Practice Address - Phone:631-482-1355
Practice Address - Fax:631-482-1356
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-25
Last Update Date:2010-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
No207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac ElectrophysiologyGroup - Multi-Specialty