East Elm Pediatrics

Primary specialty

Pediatric Adolescent Medicine PhysicianTaxonomy code 2080A0000X

License

155179 Issued in MA

Legal business name

EAST ELM PEDIATRICS

Practice address

426 East St
Pittsfield, MA 01201-5308

Phone

(413) 442-8267

Fax

(413) 442-8253

NPI assigned

May 3, 2012

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. John C Dallenbach, MD

Title

Owner

Phone

(413) 442-8267

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1336003200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1336003200000",
    "number": "1215296777",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "426 EAST ST",
            "city": "PITTSFIELD",
            "state": "MA",
            "postal_code": "012015308",
            "telephone_number": "413-442-8267",
            "fax_number": "413-442-8253"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "426 EAST ST",
            "city": "PITTSFIELD",
            "state": "MA",
            "postal_code": "012015308",
            "telephone_number": "413-442-8267",
            "fax_number": "413-442-8253"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EAST ELM PEDIATRICS",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-05-03",
        "last_updated": "2012-05-03",
        "status": "A",
        "authorized_official_last_name": "DALLENBACH",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "413-442-8267",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "2080A0000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics, Adolescent Medicine",
            "state": "MA",
            "license": "155179",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3172473",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Carleen Duquette
• Meghan Durgin
• Zulfiqar Ali Durrani, DMD
• Audrey Helena Duso
• Medhat Mongy Dwidar, DDS
• East Elm Pediatrics
• Ashabilan Ebrahim, MD
• Ebsworth Voice Wellness PLLC
• Rhonda Eckler
• Jessica L Eddy, DPT

• Pediatric Adolescent Medicine Physician in Pittsfield, MA
• Providers in Pittsfield, MA by specialty
• Pediatric Adolescent Medicine Physician in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 3, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.