Healthcare Provider Details

I. General information

NPI: 1124532270
Provider Name (Legal Business Name): PROGRESSIVE CARE MEDICAL GROUP OF NJ, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/28/2017
Last Update Date: 09/25/2026
Certification Date: 09/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29 ORIOLE WAY
MOORESTOWN NJ
08057-1335
US

IV. Provider business mailing address

PO BOX 1040
SYOSSET NY
11791-0010
US

V. Phone/Fax

Practice location:
  • Phone: 800-860-3274
  • Fax: 888-910-1059
Mailing address:
  • Phone: 800-860-3274
  • Fax: 888-910-1059

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DR. DEEPAK RAMESHCHANDRA PATEL
Title or Position: OWNER/AUTHORIZED OFFICIAL
Credential: MD
Phone: 845-339-5100