NPIMap

Organization Active NPI

W & R Geyser Rd, LLC

  • Dentist
  • Ballston Spa, NY
National Provider Identifier
1376874461
Registry record updated Feb 20, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
32884 Issued in NY
Legal business name
W & R GEYSER RD, LLC
Practice address
424 Geyser Rd
Ballston Spa, NY 12020-3021
Phone
(518) 885-1095
Fax
(518) 885-1137
NPI assigned
Jan 29, 2010
Last updated
Feb 20, 2017By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 20, 2017

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

Authorized official

Name
Dr. Nicholas J. Chauvin
Title
Owner
Phone
(518) 885-1095

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X 32884 NY Primary

Addresses

Primary practice location

424 Geyser Rd
Ballston Spa, NY 12020-3021

Mailing address

424 Geyser Rd
Ballston Spa, NY 12020-3021
Phone (518) 885-1095

Other identifiers 1

IdentifierTypeStateIssuer
00527913MedicaidNY

National Provider Directory

National Provider Directory

Locations

424 Geyser Rd
Ballston Spa, NY 12020
Phone (518) 885-1095

Practitioners & affiliated clinicians

Practitioners 2

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": "1264723200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1487548800000",
    "number": "1376874461",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "424 GEYSER RD",
            "city": "BALLSTON SPA",
            "state": "NY",
            "postal_code": "120203021",
            "telephone_number": "518-885-1095",
            "fax_number": "518-885-1137"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "424 GEYSER RD",
            "city": "BALLSTON SPA",
            "state": "NY",
            "postal_code": "120203021",
            "telephone_number": "518-885-1095",
            "fax_number": "518-885-1137"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "W & R GEYSER RD, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-01-29",
        "last_updated": "2017-02-20",
        "status": "A",
        "authorized_official_last_name": "CHAUVIN",
        "authorized_official_first_name": "NICHOLAS",
        "authorized_official_middle_name": "J.",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "518-885-1095",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "NY",
            "license": "32884",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00527913",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Ballston Spa, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 20, 2017; 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.