NPIMap

Organization Active NPI

Hudson Mohawk Pediatric & Adolescent Medicine

  • Specialist
  • Ballston Lake, NY
National Provider Identifier
1306950563
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
107075 Issued in NY
Legal business name
HUDSON MOHAWK PEDIATRIC & ADOLESCENT MEDICINE
Practice address
318 Ruhle Rd S
Ballston Lake, NY 12019-1030
Phone
(518) 899-4133
Fax
(518) 899-5764
NPI assigned
Aug 17, 2006
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Gayle B Buckley, M.D.NPI 1972587681
Title
Owner/Physician
Phone
(518) 899-4133

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
SpecialistGroup: 193400000X SINGLE SPECIALTY GROUP 174400000X 107075 NY Primary

Addresses

Primary practice location

318 Ruhle Rd S
Ballston Lake, NY 12019-1030

Mailing address

318 Ruhle Rd S
Ballston Lake, NY 12019-1030
Phone (518) 899-4133

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1155772800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1306950563",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "318 RUHLE RD S",
            "city": "BALLSTON LAKE",
            "state": "NY",
            "postal_code": "120191030",
            "telephone_number": "518-899-4133",
            "fax_number": "518-899-5764"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "318 RUHLE RD S",
            "city": "BALLSTON LAKE",
            "state": "NY",
            "postal_code": "120191030",
            "telephone_number": "518-899-4133",
            "fax_number": "518-899-5764"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HUDSON MOHAWK PEDIATRIC & ADOLESCENT MEDICINE",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-17",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "BUCKLEY",
        "authorized_official_first_name": "GAYLE",
        "authorized_official_middle_name": "B",
        "authorized_official_title_or_position": "OWNER/PHYSICIAN",
        "authorized_official_telephone_number": "518-899-4133",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "NY",
            "license": "107075",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Ballston Lake, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.