Provider Demographics
NPI:1265466395
Name:GRESSINE, NADIE C (MD)
Entity Type:Individual
Prefix:
First Name:NADIE
Middle Name:C
Last Name:GRESSINE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:NADIE
Other - Middle Name:C
Other - Last Name:JEAN-CHARLES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:52 W UNDERWOOD ST
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32806-1110
Mailing Address - Country:US
Mailing Address - Phone:321-842-8475
Mailing Address - Fax:407-849-6470
Practice Address - Street 1:52 W UNDERWOOD ST
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806-1110
Practice Address - Country:US
Practice Address - Phone:321-842-8475
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2023-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME1001772085R0202X
NY2280162085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLNS531OtherMEDICARE PTAN OHRI
FLPT353OtherMEDICARE PTAN OHMG
FL001111100Medicaid
FL145MZOtherBCBS
NY665T51Medicare ID - Type Unspecified
SCQ0017AMedicaid
NY02901100Medicaid
ID808255100Medicaid
NY0560CFMedicare PIN
FLK4672Medicare PIN