| Progressive Medical Pllc | |
|
455 Jersey St Staten Island NY 10301-2976 | |
| (718) 524-5611 | |
| Not Available |
| Full Name | Progressive Medical Pllc |
|---|---|
| Speciality | Internal Medicine |
| Location | 455 Jersey St, Staten Island, New York |
| Authorized Official Name and Position | Ellis Enabosi (OWNER) |
| Authorized Official Contact | 9732809600 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Progressive Medical Pllc 460 N Maple Ave East Orange NJ 07017-4674 Ph: () - | Progressive Medical Pllc 455 Jersey St Staten Island NY 10301-2976 Ph: (718) 524-5611 |
| NPI Number | 1508413097 |
|---|---|
| Provider Enumeration Date | 08/20/2019 |
| Last Update Date | 12/23/2019 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1508413097 | NPI | - | NPPES |
| 04996732 | Medicaid | NY |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
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