Healthcare Provider Details

I. General information

NPI: 1790190015
Provider Name (Legal Business Name): PROGRESSIVE SPINE AND SPORTS MEDICINE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/25/2014
Last Update Date: 10/30/2024
Certification Date: 10/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

385 S MAPLE AVE STE 101
GLEN ROCK NJ
07452-1545
US

IV. Provider business mailing address

385 S MAPLE AVE STE 101
GLEN ROCK NJ
07452-1545
US

V. Phone/Fax

Practice location:
  • Phone: 201-962-9199
  • Fax: 201-962-9198
Mailing address:
  • Phone: 201-962-9199
  • Fax: 201-962-9198

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number25MB08770900
License Number StateNJ

VIII. Authorized Official

Name: DR. STEVEN M FERRER
Title or Position: OWNER
Credential: MD
Phone: 732-771-6455