Healthcare Provider Details

I. General information

NPI: 1235126145
Provider Name (Legal Business Name): BERKSHIRE RADIOLOGICAL ASSOC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2005
Last Update Date: 12/06/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 STATE RTE 20
NEW LEBANON NY
12125-0417
US

IV. Provider business mailing address

PO BOX 417
NEW LEBANON NY
12125-0417
US

V. Phone/Fax

Practice location:
  • Phone: 518-794-7216
  • Fax: 518-794-0180
Mailing address:
  • Phone: 518-794-7216
  • Fax: 518-794-0180

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: MS. DEBBIE CAHILL
Title or Position: OFFICE MANAGER
Credential:
Phone: 518-794-7216