Champlain Valley Gastroenterlogy PC

Primary specialty

Gastroenterology PhysicianTaxonomy code 207RG0100X

License

220526 Issued in NY

Legal business name

CHAMPLAIN VALLEY GASTROENTERLOGY PC

Practice address

164 Boynton Avenue
Suite 5
Plattsburgh, NY 12901

Phone

(518) 324-7920

Fax

(518) 324-7922

NPI assigned

Dec 4, 2006

Organization subpart

No

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

Authorized official

Name

Dr. Jeffrey Gretz, MD

Title

Owner

Phone

(518) 324-7920

Specialties & licenses 1

Addresses

Other identifiers 2

Locations

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

{
    "created_epoch": "1165190400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1426118400000",
    "number": "1912075250",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "164 BOYNTON AVENUE",
            "address_2": "SUITE 5",
            "city": "PLATTSBURGH",
            "state": "NY",
            "postal_code": "12901",
            "telephone_number": "518-324-7920",
            "fax_number": "518-324-7922"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "164 BOYNTON AVENUE",
            "address_2": "SUITE 5",
            "city": "PLATTSBURGH",
            "state": "NY",
            "postal_code": "12901",
            "telephone_number": "518-324-7920",
            "fax_number": "518-324-7922"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHAMPLAIN VALLEY GASTROENTERLOGY PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-04",
        "last_updated": "2015-03-12",
        "status": "A",
        "authorized_official_last_name": "GRETZ",
        "authorized_official_first_name": "JEFFREY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "518-324-7920",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207RG0100X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "NY",
            "license": "220526",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02180243",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "100015503",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Champlain Valley Education Services
• Champlain Valley Family Center
• Champlain Valley Medical Anesthesia Services, PC
• Champlain Valley Open MRI LLC
• Champlain Valley Pathology, PLLC
• Champlain Valley Physicians Hospital Medical Center
• Champlain Valley Physicians Hospital Medical Center (Champlain Valley Physicians Medical Center Pharmacy)

• Gastroenterology Physician in Plattsburgh, NY
• Providers in Plattsburgh, NY by specialty
• Gastroenterology Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 12, 2015; 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.