Provider Demographics
NPI:1023015880
Name:HIRSCH, KENNETH MICHAEL (MD)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:MICHAEL
Last Name:HIRSCH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 HOMESTEAD DR
Mailing Address - Street 2:STE H
Mailing Address - City:COLUMBUS
Mailing Address - State:NJ
Mailing Address - Zip Code:08022-1005
Mailing Address - Country:US
Mailing Address - Phone:609-424-0340
Mailing Address - Fax:609-298-7452
Practice Address - Street 1:25 HOMESTEAD DR
Practice Address - Street 2:STE H
Practice Address - City:COLUMBUS
Practice Address - State:NJ
Practice Address - Zip Code:08022-1005
Practice Address - Country:US
Practice Address - Phone:609-424-0340
Practice Address - Fax:609-298-7452
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA04122800208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics