1396786554 NPI number — DR. KAREN BRUCK MD

Table of content: DR. KAREN BRUCK MD (NPI 1396786554)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396786554 NPI number — DR. KAREN BRUCK MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BRUCK
Provider First Name:
KAREN
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1396786554
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/18/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
725 NORTH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PITTSFIELD
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01201-4124
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
413-395-7572
Provider Business Mailing Address Fax Number:
413-553-6760

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
20 ELM ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PITTSFIELD
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01201-6502
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
413-442-1019
Provider Business Practice Location Address Fax Number:
413-447-8521
Provider Enumeration Date:
06/09/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  015725 , registered in the state of ME ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 201300 . This is a "MED A BHMH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 20Z300 . This is a "MEDICARE A BHMH SWING BED" identifier . This identifiers is of the category "OTHER".
  • Identifier: 102380100 . This is a "MEDICAID BHMH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 200051 . This is a "MEDICARE B BHMH" identifier . This identifiers is of the category "OTHER".
  • Identifier: AA105016 . This is a "HARVARD PILGRIM" identifier . This identifiers is of the category "OTHER".
  • Identifier: SX3479 . This is a "MED B BHMH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 061408 . This is a "ANTHEM" identifier . This identifiers is of the category "OTHER".
  • Identifier: 7243065 . This is a "AETNA HMO" identifier . This identifiers is of the category "OTHER".




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