=====================================================
General NPI Number Information
=====================================================
NPI Number | 1194705459
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PITTSFIELD CARDIOLOGY, PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/20/2006
-----------------------------------------------------
Last Update Date | 02/18/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 188 EAST STREET SUITE 102
-----------------------------------------------------
City | PITTSFIELD
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01201-4102
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 413-442-4001
-----------------------------------------------------
Fax | 413-442-8856
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 2448
-----------------------------------------------------
City | PITTSFIELD
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01202-2448
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 413-442-4001
-----------------------------------------------------
Fax | 413-442-8856
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. DANIEL S KUSICK
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 413-442-4001
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------