Provider Demographics
NPI:1285821447
Name:BERKSHIRE FACIAL SURGERY INC
Entity type:Organization
Organization Name:BERKSHIRE FACIAL SURGERY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:PAOLELLA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD MD
Authorized Official - Phone:413-562-1100
Mailing Address - Street 1:53 SOUTHAMPTON ROAD
Mailing Address - Street 2:SUITE 5
Mailing Address - City:WESTFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01085-1382
Mailing Address - Country:US
Mailing Address - Phone:413-562-1100
Mailing Address - Fax:413-562-3653
Practice Address - Street 1:53 SOUTHAMPTON ROAD
Practice Address - Street 2:SUITE 5
Practice Address - City:WESTFIELD
Practice Address - State:MA
Practice Address - Zip Code:01085-1382
Practice Address - Country:US
Practice Address - Phone:413-562-1100
Practice Address - Fax:413-562-3653
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BERKSHIRE FACIAL SURGERY INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-10-01
Last Update Date:2007-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAX08683OtherBCBS
MAX08683OtherBCBS