Active NPI
Progressive Radiology, LLC
- Diagnostic Radiology Physician
- Hoboken, NJ
National Provider Identifier
1871538223
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Diagnostic Radiology Physician
- Legal business name
- PROGRESSIVE RADIOLOGY, LLC
- Practice address
- 308 Willow Ave
Radiology Department
Hoboken, NJ 07030-3808 - Phone
- (201) 418-1820
- Fax
- (201) 418-1822
- NPI assigned
- Jun 19, 2006
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Dr. Phillip Farokh Bahramipour, M.D.
- Title
- President
- Phone
- (201) 418-1820
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Diagnostic Radiology Physician | 2085R0202X | Primary |
Addresses
Primary practice location
308 Willow Ave
Radiology Department
Hoboken, NJ 07030-3808
Mailing address
10335 N Port Washington Rd
Suite 250
Mequon, WI 53092-5763
Phone (262) 240-9870
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 9058907 | Medicaid | NJ |
National Provider Directory
National Provider DirectoryLocations
268 Mlk Jr Blvd
Newark, NJ 07102
Phone (973) 877-2580
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1150675200000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1193788800000",
"number": "1871538223",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "10335 N PORT WASHINGTON RD",
"address_2": "SUITE 250",
"city": "MEQUON",
"state": "WI",
"postal_code": "530925763",
"telephone_number": "262-240-9870",
"fax_number": "262-240-9869"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "308 WILLOW AVE",
"address_2": "RADIOLOGY DEPARTMENT",
"city": "HOBOKEN",
"state": "NJ",
"postal_code": "070303808",
"telephone_number": "201-418-1820",
"fax_number": "201-418-1822"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "PROGRESSIVE RADIOLOGY, LLC",
"organizational_subpart": "NO",
"enumeration_date": "2006-06-19",
"last_updated": "2007-10-31",
"status": "A",
"authorized_official_last_name": "BAHRAMIPOUR",
"authorized_official_first_name": "PHILLIP",
"authorized_official_middle_name": "FAROKH",
"authorized_official_title_or_position": "PRESIDENT",
"authorized_official_telephone_number": "201-418-1820",
"authorized_official_name_prefix": "Dr.",
"authorized_official_credential": "M.D."
},
"taxonomies": [
{
"code": "2085R0202X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Radiology, Diagnostic Radiology",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "9058907",
"state": "NJ"
}
],
"endpoints": [],
"other_names": []
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Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 31, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.