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General NPI Number Information
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NPI Number | 1386957116
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Entity Type | Organization
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Legal Business Name | BERKSHIRE BRAIN INJURY & NEUROLOGICAL SERVICES, P.C.
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Dates
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Enumeration Date | 07/21/2010
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Last Update Date | 06/17/2013
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Provider Practice Location Address
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Address Line | 210 SOUTH ST
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City | PITTSFIELD
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State | MA
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Zip | 01201-6825
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Country | US
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Telephone | 413-464-0290
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Fax | 413-464-0292
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Provider Business Mailing Address
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Address Line | 210 SOUTH ST
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City | PITTSFIELD
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State | MA
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Zip | 01201-6825
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Country | US
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Telephone | 413-464-0290
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Fax | 413-464-0292
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ELLEN MARIE DEIBERT
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Credential | M.D.
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Telephone | 413-464-0290
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number | 217893
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License Number State | MA
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