THEODORE S. PABST III (NPI# 1528208881) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1528208881 |
| Entity Type | Organization |
| Organization Name | THEODORE S. PABST III |
| Other Organization Name | CHAMPLAIN VALLEY VASCULAR SURGERY PLLC |
| Practice Address |
206 Cornelia St Suite 104 Plattsburgh NY 12901-2779 |
| Practice Telephone | 5185627557 |
| Practice Fax Number | 5185627559 |
| Mailing Telephone | 5185627557 |
| Mailing Fax Number | 5185627559 |
| Enumeration Date | 2009-02-26 |
| Last Update Date | 2010-04-06 |
| Authorized Official Name | DR. THEODORE SHUSTER PABST III (OWNER) |
| Authorized Official Telephone | 5185627557 |
| Authorized Official Credential | M.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 2086S0129X |
Surgery Specialization: Vascular Surgery |
203101-1 | NY | Allopathic & Osteopathic Physicians |
| Y | 2086S0129X |
Surgery Specialization: Vascular Surgery |
187640-1 | NY | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NY | 01972430 | 05 | |
| NY | 01276613 | 05 |
| Other Name | Type Code |
|---|---|
| CHAMPLAIN VALLEY VASCULAR SURGERY PLLC | Other Name - Individual/Organization |
| Street Address |
206 CORNELIA ST SUITE 104 |
| City | PLATTSBURGH |
| State | NY |
| Zip Code | 12901-2779 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1710983531 | Nancy E Zahn | Nurse Practitioner | 206 Cornelia St, Suite 306, Plattsburgh, NY 12901-2779 | 2005-06-27 |
| 1881139863 | Grant Shannon | Nurse Practitioner | 206 Cornelia St, Suite 105, Plattsburgh, NY 12901-2878 | 2016-12-29 |
| 1437540390 | Gina Kruml | Nurse Practitioner | 206 Cornelia St, Suite 306, Plattsburgh, NY 12901-2779 | 2015-02-13 |
| 1942564299 | Jessica Rose Scott | Nurse Practitioner | 206 Cornelia St, Suite 202, Plattsburgh, NY 12901-2779 | 2012-07-02 |
| 1518284199 | Boris Y Chulpayev | Specialist | 206 Cornelia St, Suite 102, Plattsburgh, NY 12901-2779 | 2010-04-22 |
| 1659606481 | Lauren Ann Caniano | Nurse Practitioner | 206 Cornelia St, 307, Plattsburgh, NY 12901-2779 | 2009-10-13 |
| 1205066180 | Dennis Evgenyevich Radoshkevich | Obstetrics & Gynecology | 206 Cornelia St, Suite 202, Plattsburgh, NY 12901-2779 | 2009-07-25 |
| 1770722084 | Charlotte A Gosrich | Nutritionist | 206 Cornelia St, Suite 103, Plattsburgh, NY 12901-2779 | 2009-02-10 |
| 1558514497 | Jessica Rae Hatfield | Physician Assistant | 206 Cornelia St, Suite 104, Plattsburgh, NY 12901-2779 | 2008-10-23 |
| 1447415971 | Sadaf N Mir | Internal Medicine | 206 Cornelia St, Suite 307, Plattsburgh, NY 12901-2878 | 2008-07-24 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1093284721 | Get Movin Inc | Non-emergency Medical Transport (VAN) | 316 Cornelia St, 21a, Plattsburgh, NY 12901 | 2018-11-26 |
| 1528536141 | Inmaculada Ibanez-casas | Technician | Sibley Hall, 113 Rugar Street, Plattsburgh, NY 12901 | 2018-11-13 |
| 1760950372 | Martha R Wasserbauer | Dietetic Technician, Registered | Mountain View Pediatrics, 18 Feathers Drive, Plattsburgh, NY 12901 | 2018-11-13 |
| 1568958411 | Joel Cherian | Student in an Organized Health Care Education/Training Program | 159 Margaret St Ste 100, Plattsburgh, NY 12901 | 2018-07-03 |
| 1396284477 | Florence Reynaud | Acupuncturist | 135 S. Peru Street, Adirondack Integrative Wellness Center, Plattsburgh, NY 12901 | 2017-02-22 |
| 1124565783 | Mytchel Hector | Registered Nurse | 43 Hamilton Street Apt #202, Plattsburgh, NY 12901 | 2017-01-20 |
| 1780136697 | Michael Bruso | Psychologist | 5436 Peru St. Apt. 5, Plattsburgh, NY 12901 | 2016-10-26 |
| 1902357536 | Ashley Patricia Cota | Nurse Practitioner | 214 Cornelia St., Plattsburgh, NY 12901 | 2016-10-19 |
| 1255703310 | Kenneth Wayne Ackley | Licensed Practical Nurse | 16 Ampersand Drive, Plattsbugh, NY 12901 | 2015-10-28 |
| 1275949448 | Shanni Lee Hicks | Specialist | 63 Arnold Rd, Plattsburgh, NY 12901 | 2014-07-08 |
| Find all providers in zip 12901 | ||||
| Taxonomy Code | 2086S0129X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Surgery |
| Specialization | Vascular Surgery |
| A surgeon with expertise in the management of surgical disorders of the blood vessels, excluding the intracranial vessels or the heart. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Surgery, 2007. http://www.absurgery.org/. American Osteopathic Board of Surgery, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Surgery. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Surgery. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1689636052 | Craig A Nachbauer | Surgery | 45 Smithfield Blvd, Plattsburgh, NY 12901-2111 | 2006-04-03 |
| 1275775298 | North Country Thoracic & Vascular, PC | Surgery | 12 Healey Ave, Plattsburgh, NY 12901-2413 | 2009-04-06 |
| 1508967563 | Theodore Shuster Pabst IIi | Surgery | 206 Cornelia St, Suite 104, Plattsburgh, NY 12901-2779 | 2006-09-25 |
| 1932191079 | Claude R Roland | Surgery | 206 Cornelia St, Suite 104, Plattsburgh, NY 12901-2779 | 2005-08-16 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1962003509 | Gs Medical, P.C. | Surgery | 377-b Pearsall Ave, Cedarhurst, NY 11516 | 2020-11-02 |
| 1073128971 | New York Vascular Group, Pllc | Surgery | 19 Laurel Ave Ste 102, Cornwall, NY 12518-1403 | 2020-09-09 |
| 1578190179 | Camilo Jose Martinez | Surgery | 23 S Howell Ave Ste H, Centereach, NY 11720-4445 | 2020-03-24 |
| 1407483399 | Interventional Medicine | Surgery | 1122a Coney Island Ave, Brooklyn, NY 11230-2307 | 2020-03-23 |
| 1487287975 | Syracuse Professional Medical Services of New York LLC | Surgery | 1101 Erie Blvd E Ste 201a, Syracuse, NY 13210-1144 | 2020-02-13 |
| 1457983181 | Syracuse Medical of New York LLC | Surgery | 1101 Erie Blvd E Ste 201b, Syracuse, NY 13210-1144 | 2020-02-11 |
| 1366914483 | Star Veins Centers PC | Surgery | 225 W 35th St Frnt 2, New York, NY 10001-1904 | 2018-12-31 |
| 1528547312 | Norwood Professional Medical Services of New York LLC | Surgery | 3487-89 Jerome Ave, Ste A, Bronx, NY 10468 | 2018-08-13 |
| 1336628130 | Norwood Medical of New York LLC | Surgery | 3487-89 Jerome Ave, Ste B, Bronx, NY 10468 | 2018-08-13 |
| 1003393299 | Bushwick Professional Medical Services of New York LLC | Surgery | 441 Knickerbocker Ave Ste A, Brooklyn, NY 11237-4508 | 2018-07-20 |
| Find all providers with the same taxonomy | ||||
| City | PLATTSBURGH |
| Zip Code | 12901 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.