Healthcare Provider Details

I. General information

NPI: 1700186814
Provider Name (Legal Business Name): PROGRESSIVE ARRHYTHMIA & CARDIAC CARE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/25/2010
Last Update Date: 10/25/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1350 DEER PARK AVE
NORTH BABYLON NY
11703-1619
US

IV. Provider business mailing address

1350 DEER PARK AVE
NORTH BABYLON NY
11703-1619
US

V. Phone/Fax

Practice location:
  • Phone: 631-482-1355
  • Fax: 631-482-1356
Mailing address:
  • Phone: 631-482-1355
  • Fax: 631-482-1356

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. EILLEEN MARTINEZ
Title or Position: CREDENTIALING LAISON
Credential:
Phone: 631-482-1355