MEDICARE: PROGRESSIVE X-RAY OF KEARNY, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QR0200X	Radiology Clinic/Center

General Provider Information

NPI Number	:	1184864795
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PROGRESSIVE X-RAY OF KEARNY, LLC

Provider Business Mailing Address
First Line	:	401 SYLVAN AVE
Second Line	:
City	:	ENGLEWOOD CLIFFS
State	:	NJ
Zip	:	07632-2703
Country	:	US
Telephone Number	:	201-541-5401
Fax Number	:	201-816-1724

Provider Business Practice Location Address
First Line	:	816 KEARNY AVE
Second Line	:
City	:	KEARNY
State	:	NJ
Zip	:	07032-3148
Country	:	US
Telephone Number	:	201-316-3295
Fax Number	:	201-933-5662

Authorized Official
Title or Position	:	VP OF OPERATIONS
Name	:	MR. MARCEL PIROVANO
Credential	:
Telephone Number	:	201-541-5401

Provider Enumeration Date	:	02/23/2009
Last Update Date	:	02/23/2009

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