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General NPI Number Information
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NPI Number | 1043465289
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Entity Type | Organization
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Legal Business Name | PROGRESSIVE MEDICAL ASSOCIATES, P.C
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Dates
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Enumeration Date | 12/01/2008
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Last Update Date | 12/01/2008
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Provider Practice Location Address
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Address Line | 90 E END AVE
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City | NEW YORK
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State | NY
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Zip | 10028-8000
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Country | US
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Telephone | 212-734-8877
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Fax | 212-734-2366
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Provider Business Mailing Address
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Address Line | 161 MADISON AVE 7SE
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City | NEW YORK
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State | NY
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Zip | 10016-5421
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Country | US
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Telephone | 212-734-8877
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Fax | 212-734-2366
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. DAVID BOLON
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Credential | M.D
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Telephone | 212-734-8877
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 173000000X
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Taxonomy Name | Legal Medicine
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License Number |
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License Number State |
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