MEDICARE: PROGRESSIVE SPINE AND SPORTS MEDICINE

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
1	2081P2900X	Pain Medicine (Physical Medicine & Rehabilitation) Physician	25MB08770900	NJ

General Provider Information

NPI Number	:	1790190015
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PROGRESSIVE SPINE AND SPORTS MEDICINE

Provider Business Mailing Address
First Line	:	385 S MAPLE AVE STE 101
Second Line	:
City	:	GLEN ROCK
State	:	NJ
Zip	:	07452-1545
Country	:	US
Telephone Number	:	201-962-9199
Fax Number	:	201-962-9198

Provider Business Practice Location Address
First Line	:	385 S MAPLE AVE STE 101
Second Line	:
City	:	GLEN ROCK
State	:	NJ
Zip	:	07452-1545
Country	:	US
Telephone Number	:	201-962-9199
Fax Number	:	201-962-9198

Authorized Official
Title or Position	:	OWNER
Name	:	DR. STEVEN M FERRER
Credential	:	MD
Telephone Number	:	732-771-6455

Provider Enumeration Date	:	06/25/2014
Last Update Date	:	10/30/2024

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