Healthcare Provider Details

I. General information

NPI: 1245231893
Provider Name (Legal Business Name): BERKSHIRE ALLERGY & ASTHMA CENTER, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/04/2005
Last Update Date: 08/10/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2210 RIDGEWOOD RD SUITE 100
WYOMISSING PA
19610-1167
US

IV. Provider business mailing address

2210 RIDGEWOOD RD SUITE 100
WYOMISSING PA
19610-1167
US

V. Phone/Fax

Practice location:
  • Phone: 610-372-0502
  • Fax: 610-372-9554
Mailing address:
  • Phone: 610-372-0502
  • Fax: 610-372-9554

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207KA0200X
TaxonomyAllergy Physician
License NumberMD034450E
License Number StatePA

VIII. Authorized Official

Name: DR. EDWARD W. HEIN
Title or Position: PRESIDENT
Credential: M.D.
Phone: 610-372-0502