Provider Demographics
NPI:1235126145
Name:BERKSHIRE RADIOLOGICAL ASSOC
Entity Type:Organization
Organization Name:BERKSHIRE RADIOLOGICAL ASSOC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:DEBBIE
Authorized Official - Middle Name:
Authorized Official - Last Name:CAHILL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:518-794-7216
Mailing Address - Street 1:PO BOX 417
Mailing Address - Street 2:
Mailing Address - City:NEW LEBANON
Mailing Address - State:NY
Mailing Address - Zip Code:12125-0417
Mailing Address - Country:US
Mailing Address - Phone:518-794-7216
Mailing Address - Fax:518-794-0180
Practice Address - Street 1:501 STATE RTE 20
Practice Address - Street 2:
Practice Address - City:NEW LEBANON
Practice Address - State:NY
Practice Address - Zip Code:12125-0417
Practice Address - Country:US
Practice Address - Phone:518-794-7216
Practice Address - Fax:518-794-0180
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-05
Last Update Date:2007-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02140009Medicaid
MA9705350Medicaid
MAM17600OtherBLUE SHIELD MA
NY000498245001OtherEMPIRE BLUE SHIELD
NYWTG161Medicare PIN
MAM17600OtherBLUE SHIELD MA