PROGRESSIVE SURGERY CENTER LLC NPI 1477645711

NPI Information

NPI: 1477645711
Provider Name: PROGRESSIVE SURGERY CENTER LLC
Classification: Clinic/Center - 261QA1903X
Entity Type: Organization

Specialization: Ambulatory Surgical

CLIA Number: 33D1013662

Address:
340 BROADHOLLOW RD
FARMINGDALE, NY
ZIP 11735
Phone: (631) 694-0000
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PROGRESSIVE SURGERY CENTER LLC is an ambulatory surgical clinic center in Farmingdale, NY. PROGRESSIVE SURGERY CENTER LLC NPI is 1477645711. The provider is registered as an organization entity type.

The provider's business location address is:

340 BROADHOLLOW RD
FARMINGDALE, NY
ZIP 11735-807
Phone: (631) 694-0000
Fax: (631) 694-2470

The provider's authorized official is Kendel D Mckenna .
The authorized official title is Administrator and has the following contact phone number (631) 694-0000.

The CLIA number assigned to this NPI record is 33D1013662 - ambulatory surgery center with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 9/28/2006 and was last updated on 5/7/2012.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	261QA1903X	Clinic/Center	Ambulatory Surgical	5150202R	NEW YORK	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	Z62361	MEDICARE ID-TYPE UNSPECIFIED		CMS
2	02490288	MEDICAID	NEW YORK

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

NPI Synchronization or Removal

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