# CHAMPLAIN VALLEY VASCULAR SURGERY

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Theodore S Pabst III
- **Organization subpart:** No

## Provider details

- **NPI number:** 1528208881
- **Authorized official:** DR. THEODORE SHUSTER PABST III M.D. (CEO)
- **Authorized official phone:** (518) 562-7557

## Contact information

- **Practice address:** 24 HAMMOND LANE, PLATTSBURGH, NY 12901
- **Practice address phone:** (518) 562-7557
- **Practice address fax:** (518) 562-7559
- **Mailing address:** 24 HAMMOND LANE, PLATTSBURGH, NY 12901
- **Mailing address phone:** (518) 562-7557
- **Mailing address fax:** (518) 562-7559

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 2086S0129X | Vascular Surgery Physician | 187640-1 | NY | — |
| 2086S0129X | Vascular Surgery Physician | 203101-1 | NY | — |
| 2086S0129X | Vascular Surgery Physician | — | NULL | Yes |
| 2086S0129X | Vascular Surgery Physician | — | — | Yes |
| 363LG0600X | Gerontology Nurse Practitioner | — | NULL | — |
| 363LG0600X | Gerontology Nurse Practitioner | — | — | — |

## Other

- **Enumeration date:** 02/26/2009
- **Last updated:** 03/03/2023