Provider Demographics
NPI:1881651024
Name:GRESSEL, VLADIMIR (MD)
Entity Type:Individual
Prefix:DR
First Name:VLADIMIR
Middle Name:
Last Name:GRESSEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 HEMLOCK TER S
Mailing Address - Street 2:
Mailing Address - City:GREENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18426-4463
Mailing Address - Country:US
Mailing Address - Phone:570-676-4194
Mailing Address - Fax:
Practice Address - Street 1:109 HEMLOCK TER S
Practice Address - Street 2:
Practice Address - City:GREENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18426-4463
Practice Address - Country:US
Practice Address - Phone:570-676-4194
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-01
Last Update Date:2016-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY203933208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY2216966OtherAETNA HMO
NY5015626OtherAETNA PPO
NYBK0078803OtherAMERICHOICE WE
NYGV3933OtherATLANTIS
NY113414745OtherUNITED HEALTHCARE
NY113414745OtherMULTIPLAN
NYVG00T55400OtherEMPIRE BCBS
NY0T5541OtherBCBS
NY1C5997OtherHEALTHNET
NY01739977Medicaid
NY1134147456GR01OtherCAREPLUS HEALTH PLAN
NYBK0078801OtherAMERICHOICE PA
NYP00000019516OtherGHI MEDICARE
NYP836019OtherOXFORD
NY203933OtherHIP
NY204666OtherWELLCARE
NY2799767OtherGHI
NY5015626OtherAETNA PPO
NYGV3933OtherATLANTIS