Gregory W Runkel, MD

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

192862 Issued in NY

Practice address

102 Race Track Rd
Suite 1
Ticonderoga, NY 12883-4004

Phone

(518) 585-6708

Fax

(518) 585-3260

NPI assigned

Jul 28, 2006

Last updated

Feb 1, 2017By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

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

{
    "created_epoch": "1154044800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1485907200000",
    "number": "1972517837",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9 CAREY RD",
            "city": "QUEENSBURY",
            "state": "NY",
            "postal_code": "128047880",
            "telephone_number": "518-761-0300",
            "fax_number": "518-824-2388"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "102 RACE TRACK RD",
            "address_2": "SUITE 1",
            "city": "TICONDEROGA",
            "state": "NY",
            "postal_code": "128834004",
            "telephone_number": "518-585-6708",
            "fax_number": "518-585-3260"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUNKEL",
        "first_name": "GREGORY",
        "middle_name": "W",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-28",
        "last_updated": "2017-02-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NY",
            "license": "192862",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01700283",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Pediatrics Physician in Ticonderoga, NY
• Providers in Ticonderoga, NY by specialty
• Pediatrics Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 1, 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.