MEDICARE: PROGRESSIVE DERMATOLOGY, P.C.

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	207N00000X	Dermatology Physician	233325-1	NY

General Provider Information

NPI Number	:	1801002456
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PROGRESSIVE DERMATOLOGY, P.C.

Provider Business Mailing Address
First Line	:	65 HICKORY RD # B
Second Line	:
City	:	PORT WASHINGTON
State	:	NY
Zip	:	11050-1517
Country	:	US
Telephone Number	:	516-712-9337
Fax Number	:	516-294-4569

Provider Business Practice Location Address
First Line	:	65 HICKORY RD # B
Second Line	:
City	:	PORT WASHINGTON
State	:	NY
Zip	:	11050-1517
Country	:	US
Telephone Number	:	516-712-9337
Fax Number	:	516-294-4569

Authorized Official
Title or Position	:	PHYSICIAN
Name	:	DR. ROBIN BETH SEPTON
Credential	:	M.D.
Telephone Number	:	516-712-9337

Provider Enumeration Date	:	05/14/2007
Last Update Date	:	08/22/2020

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