Provider Demographics
NPI:1992901904
Name:PROGRESSIVE DYNAMIC DESIGNS, INC.
Entity type:Organization
Organization Name:PROGRESSIVE DYNAMIC DESIGNS, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:
Authorized Official - Last Name:TSE
Authorized Official - Suffix:
Authorized Official - Credentials:CO
Authorized Official - Phone:212-396-3901
Mailing Address - Street 1:420 E 82ND ST
Mailing Address - Street 2:SUITE 1E
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10028-5901
Mailing Address - Country:US
Mailing Address - Phone:212-396-3901
Mailing Address - Fax:
Practice Address - Street 1:420 E 82ND ST
Practice Address - Street 2:SUITE 1E
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10028-5901
Practice Address - Country:US
Practice Address - Phone:212-396-3901
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYCO2850335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02499425Medicaid
NY02499425Medicaid