Provider Demographics
NPI:1114972957
Name:EAST SHORE MEDICAL PC
Entity Type:Organization
Organization Name:EAST SHORE MEDICAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:VLADIMIR
Authorized Official - Middle Name:
Authorized Official - Last Name:GRESSEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-275-0900
Mailing Address - Street 1:1110 PENNSYLVANIA AVE
Mailing Address - Street 2:SUITE 14
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11207-9061
Mailing Address - Country:US
Mailing Address - Phone:718-257-0900
Mailing Address - Fax:718-257-5622
Practice Address - Street 1:1110 PENNSYLVANIA AVE
Practice Address - Street 2:SUITE 14
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11207-9061
Practice Address - Country:US
Practice Address - Phone:718-257-0900
Practice Address - Fax:718-257-5622
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Multi-Specialty
Not Answered207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
Not Answered2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Multi-Specialty
Not Answered2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty