Provider Demographics
NPI:1437265592
Name:BERKSHIRE PODIATRY, PC
Entity Type:Organization
Organization Name:BERKSHIRE PODIATRY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CESAR
Authorized Official - Middle Name:M
Authorized Official - Last Name:MENDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:413-499-9933
Mailing Address - Street 1:740 WILLIAMS ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:PITTSFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01201
Mailing Address - Country:US
Mailing Address - Phone:413-499-9933
Mailing Address - Fax:413-499-3943
Practice Address - Street 1:740 WILLIAMS ST
Practice Address - Street 2:SUITE 2
Practice Address - City:PITTSFIELD
Practice Address - State:MA
Practice Address - Zip Code:01201
Practice Address - Country:US
Practice Address - Phone:413-499-9933
Practice Address - Fax:413-499-3943
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-22
Last Update Date:2008-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA694089OtherTUFTS HEALTH PLAN
MA9710027Medicaid
MA4318740001Medicare NSC
MAY78035Medicare PIN