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General NPI Number Information
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NPI Number | 1700186814
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Entity Type | Organization
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Legal Business Name | PROGRESSIVE ARRHYTHMIA & CARDIAC CARE PLLC
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Dates
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Enumeration Date | 10/25/2010
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Last Update Date | 10/25/2010
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Provider Practice Location Address
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Address Line | 1350 DEER PARK AVE
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City | NORTH BABYLON
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State | NY
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Zip | 11703-1619
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Country | US
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Telephone | 631-482-1355
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Fax | 631-482-1356
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Provider Business Mailing Address
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Address Line | 1350 DEER PARK AVE
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City | NORTH BABYLON
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State | NY
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Zip | 11703-1619
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Country | US
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Telephone | 631-482-1355
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Fax | 631-482-1356
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Authorized Official
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Title or Position | CREDENTIALING LAISON
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Name | MRS. EILLEEN MARTINEZ
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Credential |
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Telephone | 631-482-1355
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0001X
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Taxonomy Name | Clinical Cardiac Electrophysiology Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number |
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License Number State |
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