Healthcare Provider Details

I. General information

NPI: 1134369481
Provider Name (Legal Business Name): PROGRESSIVE GASTROENTEROLOGY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/26/2009
Last Update Date: 06/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3584 JEROME AVE
BRONX NY
10467-1006
US

IV. Provider business mailing address

3584 JEROME AVE
BRONX NY
10467-1006
US

V. Phone/Fax

Practice location:
  • Phone: 718-231-4440
  • Fax: 718-708-4821
Mailing address:
  • Phone: 718-231-4443
  • Fax: 718-708-4821

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number175708
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207ZP0101X
TaxonomyAnatomic Pathology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. MEIR SALAMA
Title or Position: OWNER
Credential: M.D.
Phone: 718-231-4443