Healthcare Provider Details

I. General information

NPI: 1114972957
Provider Name (Legal Business Name): EAST SHORE MEDICAL PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1110 PENNSYLVANIA AVE SUITE 14
BROOKLYN NY
11207-9061
US

IV. Provider business mailing address

1110 PENNSYLVANIA AVE SUITE 14
BROOKLYN NY
11207-9061
US

V. Phone/Fax

Practice location:
  • Phone: 718-257-0900
  • Fax: 718-257-5622
Mailing address:
  • Phone: 718-257-0900
  • Fax: 718-257-5622

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: VLADIMIR GRESSEL
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 718-275-0900