Provider Demographics
NPI:1467422519
Name:HORNSTEIN, EDMUND H (DO)
Entity Type:Individual
Prefix:DR
First Name:EDMUND
Middle Name:H
Last Name:HORNSTEIN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:777 NORTH ST
Mailing Address - Street 2:SUITE 201A
Mailing Address - City:PITTSFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01201-4147
Mailing Address - Country:US
Mailing Address - Phone:413-499-8551
Mailing Address - Fax:413-442-9161
Practice Address - Street 1:777 NORTH ST
Practice Address - Street 2:SUITE 201A
Practice Address - City:PITTSFIELD
Practice Address - State:MA
Practice Address - Zip Code:01201-4147
Practice Address - Country:US
Practice Address - Phone:413-499-8551
Practice Address - Fax:413-442-9161
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA153398174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01753593Medicaid
MA3166562Medicaid
MAG44851OtherHARVARD PILGRIM HEALTHCAR
MAJ17881OtherBCBSMA
NY10043697OtherCDPHP
MA20604OtherHEALTH NEW ENGLAND
MA153398OtherTUFTS HEALTHPLAN
NY362225OtherMVP
NY10043697OtherCDPHP
MAJ17881OtherBCBSMA