Healthcare Provider Details

I. General information

NPI: 1134404411
Provider Name (Legal Business Name): PROGRESSIVE NEUROLOGY, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2011
Last Update Date: 09/03/2026
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 FOREST AVENUE SUITE 150
PARAMUS NJ
07652-5245
US

IV. Provider business mailing address

6 FOREST AVENUE SUITE 150
PARAMUS NJ
07652-5245
US

V. Phone/Fax

Practice location:
  • Phone: 201-546-8510
  • Fax: 201-957-7316
Mailing address:
  • Phone: 201-546-8510
  • Fax: 201-957-7316

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number25MA08232000
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code2084N0600X
TaxonomyClinical Neurophysiology Physician
License Number25MA08232000
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code2084S0012X
TaxonomySleep Medicine (Psychiatry & Neurology) Physician
License Number25MA08232000
License Number StateNJ

VIII. Authorized Official

Name: GEORGES A. GHACIBEH
Title or Position: M.D.
Credential: M.D.
Phone: 201-546-8510