Provider Demographics
NPI:1871032904
Name:BERKSHIRE HAND TO SHOULDER CENTER LLC
Entity Type:Organization
Organization Name:BERKSHIRE HAND TO SHOULDER CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:PHILIP
Authorized Official - Last Name:NANCOLLAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:315-559-3506
Mailing Address - Street 1:3 MELVILLE CT
Mailing Address - Street 2:
Mailing Address - City:LENOX
Mailing Address - State:MA
Mailing Address - Zip Code:01240-2589
Mailing Address - Country:US
Mailing Address - Phone:315-559-3506
Mailing Address - Fax:
Practice Address - Street 1:3 MELVILLE CT
Practice Address - Street 2:
Practice Address - City:LENOX
Practice Address - State:MA
Practice Address - Zip Code:01240-2589
Practice Address - Country:US
Practice Address - Phone:315-559-3506
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-22
Last Update Date:2022-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA257785207XS0106X
MA553596225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand SurgeryGroup - Multi-Specialty
No225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHandGroup - Multi-Specialty