Healthcare Provider Details

I. General information

NPI: 1871032904
Provider Name (Legal Business Name): BERKSHIRE HAND TO SHOULDER CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/22/2017
Last Update Date: 03/28/2022
Certification Date: 03/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 MELVILLE CT
LENOX MA
01240-2589
US

IV. Provider business mailing address

3 MELVILLE CT
LENOX MA
01240-2589
US

V. Phone/Fax

Practice location:
  • Phone: 315-559-3506
  • Fax:
Mailing address:
  • Phone: 315-559-3506
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XS0106X
TaxonomyOrthopaedic Hand Surgery Physician
License Number257785
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code225XH1200X
TaxonomyHand Occupational Therapist
License Number553596
License Number StateMA

VIII. Authorized Official

Name: MICHAEL PHILIP NANCOLLAS
Title or Position: OWNER
Credential: M.D.
Phone: 315-559-3506