Organization
CHAMPLAIN VALLEY VASCULAR SURGERY
Active
Other names
Theodore S Pabst III
Organization subpart
No
Provider details
NPI number
Authorized official
DR. THEODORE SHUSTER PABST III M.D. (CEO)
(518) 562-7557
Entity
Organization
Contact information
Practice address
24 HAMMOND LANE, PLATTSBURGH, NY 12901
(518) 562-7557
(518) 562-7559
Mailing address
24 HAMMOND LANE, PLATTSBURGH, NY 12901
(518) 562-7557
(518) 562-7559
Taxonomy
Speciality
Code
Description
License number
State
2086S0129X
Vascular Surgery Physician
187640-1
NY
2086S0129X
Vascular Surgery Physician
203101-1
NY
2086S0129X
Vascular Surgery Physician
Primary
—
—
363LG0600X
Gerontology Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01276613
—
NY
05
—
01972430
—
NY
05
—
04556089
—
NY
Enumeration date
02/26/2009
Last updated
03/03/2023
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