Basic Information
| Provider Information | |||||||||
| NPI: | 1134369481 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PROGRESSIVE GASTROENTEROLOGY LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3584 JEROME AVE | ||||||||
| Address2: | |||||||||
| City: | BRONX | ||||||||
| State: | NY | ||||||||
| PostalCode: | 104671006 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7182314443 | ||||||||
| FaxNumber: | 7187084821 | ||||||||
| Practice Location | |||||||||
| Address1: | 3584 JEROME AVE | ||||||||
| Address2: | |||||||||
| City: | BRONX | ||||||||
| State: | NY | ||||||||
| PostalCode: | 104671006 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7182314440 | ||||||||
| FaxNumber: | 7187084821 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/26/2009 | ||||||||
| LastUpdateDate: | 06/10/2014 | ||||||||
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| AuthorizedOfficialLastName: | SALAMA | ||||||||
| AuthorizedOfficialFirstName: | MEIR | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 7182314443 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207ZP0101X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pathology | Anatomic Pathology | 207RG0100X | 175708 | NY | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology |
No ID Information.