Healthcare Provider Details

I. General information

NPI: 1902835564
Provider Name (Legal Business Name): FAMILY PRACTICE ASSOCIATES R TAYLOR E HEYMAN & R LEE PTRS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/03/2006
Last Update Date: 06/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 ELM ST
PITTSFIELD MA
01201-6502
US

IV. Provider business mailing address

20 ELM ST
PITTSFIELD MA
01201-6502
US

V. Phone/Fax

Practice location:
  • Phone: 413-442-1019
  • Fax: 413-447-8521
Mailing address:
  • Phone: 413-442-1019
  • Fax: 413-447-8521

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: JONATHAN GRENOBLE
Title or Position: MANAGING PARTNER
Credential: M.D.
Phone: 413-442-1019