Provider Demographics
NPI:1245231893
Name:BERKSHIRE ALLERGY & ASTHMA CENTER, INC
Entity Type:Organization
Organization Name:BERKSHIRE ALLERGY & ASTHMA CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:W
Authorized Official - Last Name:HEIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:610-372-0502
Mailing Address - Street 1:2210 RIDGEWOOD RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:WYOMISSING
Mailing Address - State:PA
Mailing Address - Zip Code:19610-1167
Mailing Address - Country:US
Mailing Address - Phone:610-372-0502
Mailing Address - Fax:610-372-9554
Practice Address - Street 1:2210 RIDGEWOOD RD
Practice Address - Street 2:SUITE 100
Practice Address - City:WYOMISSING
Practice Address - State:PA
Practice Address - Zip Code:19610-1167
Practice Address - Country:US
Practice Address - Phone:610-372-0502
Practice Address - Fax:610-372-9554
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-04
Last Update Date:2010-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD034450E207KA0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA02335300OtherCAPITAL BLUE CROSS
PA116364OtherAETNA
PA707900OtherHIGHMARK BLUE SHIELD
PA01016373Medicaid
PA01016373Medicaid
PAB96527Medicare UPIN