Healthcare Provider Details

I. General information

NPI: 1720608151
Provider Name (Legal Business Name): PROGRESSIVE MEDICAL FITNESS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/27/2020
Last Update Date: 02/16/2026
Certification Date: 02/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

389 FORT SALONGA RD STE 2
NORTHPORT NY
11768-3089
US

IV. Provider business mailing address

389 FORT SALONGA RD STE 2
NORTHPORT NY
11768-3089
US

V. Phone/Fax

Practice location:
  • Phone: 631-201-2474
  • Fax: 631-382-8325
Mailing address:
  • Phone: 631-760-8081
  • Fax: 631-651-8959

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State

VIII. Authorized Official

Name: HAROLD AVELLA
Title or Position: OWNER
Credential: MD
Phone: 631-201-2474