1255496030 NPI number — BERKSHIRE EYE CENTER, P.C.

Table of content: (NPI 1255496030)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255496030 NPI number — BERKSHIRE EYE CENTER, P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BERKSHIRE EYE CENTER, P.C.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1255496030
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/28/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
342 STOCKBRIDGE RD
Provider Second Line Business Mailing Address:
KMART PLAZA
Provider Business Mailing Address City Name:
GREAT BARRINGTON
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01230-1235
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
413-528-8911
Provider Business Mailing Address Fax Number:
413-528-2711

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
342 STOCKBRIDGE RD
Provider Second Line Business Practice Location Address:
KMART PLAZA
Provider Business Practice Location Address City Name:
GREAT BARRINGTON
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01230-1235
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
413-528-8911
Provider Business Practice Location Address Fax Number:
413-528-2711
Provider Enumeration Date:
12/22/2006

Additional Information

Authorized Official

Authorized Official Last Name:
EVENCHIK
Authorized Official First Name:
BRUCE
Authorized Official Middle Name:
G.
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
413-445-4564

Provider Taxonomy Codes

  • Taxonomy code: 332H00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: W16093 . This is a "MEDICARE PIN DR G" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 9774017 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: I22279 . This is a "MEDICARE PIN-DR EVENCHIK" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: J27719 . This is a "MEDICARE PIN DR GINSBERG" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: J09851 . This is a "MEDICARE PIN DR O" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: J03513 . This is a "MEDICARE PIN DR S" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




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