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General NPI Number Information
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NPI Number | 1790190015
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Entity Type | Organization
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Legal Business Name | PROGRESSIVE SPINE AND SPORTS MEDICINE
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Dates
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Enumeration Date | 06/25/2014
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Last Update Date | 10/30/2024
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Provider Practice Location Address
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Address Line | 385 S MAPLE AVE STE 101
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City | GLEN ROCK
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State | NJ
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Zip | 07452-1545
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Country | US
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Telephone | 201-962-9199
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Fax | 201-962-9198
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Provider Business Mailing Address
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Address Line | 385 S MAPLE AVE STE 101
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City | GLEN ROCK
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State | NJ
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Zip | 07452-1545
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Country | US
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Telephone | 201-962-9199
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Fax | 201-962-9198
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Authorized Official
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Title or Position | OWNER
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Name | DR. STEVEN M FERRER
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Credential | MD
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Telephone | 732-771-6455
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2081P2900X
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Taxonomy Name | Pain Medicine (Physical Medicine & Rehabilitation) Physician
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License Number | 25MB08770900
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License Number State | NJ
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