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General NPI Number Information
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NPI Number | 1053424812
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Entity Type | Organization
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Legal Business Name | SURGICAL SPECIALISTS OF WESTERN NEW ENGLAND PC
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Dates
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Enumeration Date | 08/16/2006
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Last Update Date | 02/11/2009
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Provider Practice Location Address
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Address Line | 510 NORTH STREET SUITE 202
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City | PITTSFIELD
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State | MA
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Zip | 01201
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Country | US
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Telephone | 413-442-2462
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Fax | 413-442-3101
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Provider Business Mailing Address
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Address Line | 510 NORTH ST SUITE 202
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City | PITTSFIELD
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State | MA
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Zip | 01201-4111
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Country | US
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Telephone | 413-442-2462
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Fax | 413-442-3101
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Authorized Official
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Title or Position | PRESIDENT
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Name | ROBERT D FANELLI
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Credential | MD
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Telephone | 413-442-2462
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number |
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License Number State |
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