Organization
CHAMPLAIN VALLEY GASTROENTERLOGY PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JEFFREY GRETZ MD (OWNER)
(518) 324-7920
Entity
Organization
Contact information
Practice address
164 BOYNTON AVENUE, SUITE 5, PLATTSBURGH, NY 12901
(518) 324-7920
(518) 324-7922
Mailing address
164 BOYNTON AVENUE, SUITE 5, PLATTSBURGH, NY 12901
(518) 324-7920
(518) 324-7922
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
Primary
220526
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02180243
—
NY
01
—
100015503
RAILROAD MEDICARE
NY
Enumeration date
12/04/2006
Last updated
03/12/2015
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