Provider Demographics
NPI:1285673186
Name:BERKSHIRE COSMETIC & RECONSTRUCTIVE SURGERY CENTER INC.
Entity Type:Organization
Organization Name:BERKSHIRE COSMETIC & RECONSTRUCTIVE SURGERY CENTER INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BASIL
Authorized Official - Middle Name:M
Authorized Official - Last Name:MICHAELS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:413-496-9272
Mailing Address - Street 1:426 SOUTH ST
Mailing Address - Street 2:
Mailing Address - City:PITTSFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01201-8228
Mailing Address - Country:US
Mailing Address - Phone:413-496-9272
Mailing Address - Fax:413-442-6990
Practice Address - Street 1:426 SOUTH ST
Practice Address - Street 2:
Practice Address - City:PITTSFIELD
Practice Address - State:MA
Practice Address - Zip Code:01201-8228
Practice Address - Country:US
Practice Address - Phone:413-496-9272
Practice Address - Fax:413-442-6990
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-06
Last Update Date:2013-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA694456OtherTUFTS
MAM88023OtherBC/BS
MA221035Medicare PIN