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NPI Code Detail

MEDICARE: PROGRESSIVE MEDICAL FITNESS PC

MEDICARE: PROGRESSIVE MEDICAL FITNESS PC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1208100000XPhysical Medicine & Rehabilitation Physician
2207Q00000XFamily Medicine Physician

General Provider Information

NPI Number : 1720608151
Entity Type Code : Organization
Provider Name (Legal Business Name) : PROGRESSIVE MEDICAL FITNESS PC
Provider Business Mailing Address
First Line : 389 FORT SALONGA RD STE 2
Second Line :
City : NORTHPORT
State : NY
Zip : 11768-3089
Country : US
Telephone Number : 631-760-8081
Fax Number : 631-651-8959
Provider Business Practice Location Address
First Line : 389 FORT SALONGA RD STE 2
Second Line :
City : NORTHPORT
State : NY
Zip : 11768-3089
Country : US
Telephone Number : 631-201-2474
Fax Number : 631-382-8325
Authorized Official
Title or Position : OWNER
Name : HAROLD AVELLA
Credential : MD
Telephone Number : 631-201-2474
Provider Enumeration Date : 04/27/2020
Last Update Date : 02/16/2026

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Directions to “PROGRESSIVE MEDICAL FITNESS PC ” Practice Location

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