1760148787 NPI number — S & M MEDICAL GROUP INC

Table of content: NADIE C. GRESSINE MD (NPI 1265466395)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760148787 NPI number — S & M MEDICAL GROUP INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
S & M MEDICAL GROUP INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1760148787
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/12/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1305 NW 2ND CIR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BOCA RATON
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33432-1417
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8461 LAKE WORTH RD STE 108
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAKE WORTH
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33467-2474
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
305-713-3230
Provider Business Practice Location Address Fax Number:
866-238-3096
Provider Enumeration Date:
11/14/2021

Additional Information

Authorized Official

Authorized Official Last Name:
RAMOS
Authorized Official First Name:
SHAUNA
Authorized Official Middle Name:
ROBYN
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
305-562-7884

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 112621000 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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