Provider Demographics
NPI:1124532270
Name:PROGRESSIVE CARE MEDICAL GROUP OF NJ, LLC
Entity type:Organization
Organization Name:PROGRESSIVE CARE MEDICAL GROUP OF NJ, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/AUTHORIZED OFFICIAL
Authorized Official - Prefix:DR
Authorized Official - First Name:DEEPAK
Authorized Official - Middle Name:RAMESHCHANDRA
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:845-339-5100
Mailing Address - Street 1:150 EILEEN WAY UNIT 1
Mailing Address - Street 2:
Mailing Address - City:SYOSSET
Mailing Address - State:NY
Mailing Address - Zip Code:11791-5313
Mailing Address - Country:US
Mailing Address - Phone:516-855-5255
Mailing Address - Fax:516-921-2451
Practice Address - Street 1:29 ORIOLE WAY
Practice Address - Street 2:
Practice Address - City:MOORESTOWN
Practice Address - State:NJ
Practice Address - Zip Code:08057-1335
Practice Address - Country:US
Practice Address - Phone:516-855-5255
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-28
Last Update Date:2022-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty