Provider Demographics
NPI:1124099031
Name:PROGRESSIVE O & P, INC
Entity type:Organization
Organization Name:PROGRESSIVE O & P, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:H
Authorized Official - Last Name:BASTIAN
Authorized Official - Suffix:
Authorized Official - Credentials:CP
Authorized Official - Phone:516-338-8585
Mailing Address - Street 1:1111 WILLIS AVENUE
Mailing Address - Street 2:
Mailing Address - City:ALBERTSON
Mailing Address - State:NY
Mailing Address - Zip Code:11507-1230
Mailing Address - Country:US
Mailing Address - Phone:516-338-8585
Mailing Address - Fax:516-338-7575
Practice Address - Street 1:1111 WILLIS AVENUE
Practice Address - Street 2:
Practice Address - City:ALBERTSON
Practice Address - State:NY
Practice Address - Zip Code:11507-1230
Practice Address - Country:US
Practice Address - Phone:516-338-8585
Practice Address - Fax:516-338-7575
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-30
Last Update Date:2011-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02072719Medicaid
NYA2005136OtherOXFORD
NY2225560OtherAETNA
NY02072719Medicaid