Healthcare Provider Details

I. General information

NPI: 1861779431
Provider Name (Legal Business Name): JAMIE L BERKOWITZ PA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/10/2011
Last Update Date: 10/04/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

777 NORTH STREET SUITE 305
PITTSFIELD MA
01201
US

IV. Provider business mailing address

P.O. BOX 30
GREAT BARRINGTON MA
01230
US

V. Phone/Fax

Practice location:
  • Phone: 413-499-8531
  • Fax: 413-499-8560
Mailing address:
  • Phone: 413-528-9311
  • Fax: 413-644-0274

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA4278
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: