Provider Demographics
NPI:1053305805
Name:KENNETH H HIRSCH DDS PC
Entity Type:Organization
Organization Name:KENNETH H HIRSCH DDS PC
Other - Org Name:DR KENNETH HIRSCH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER ORAL SURGEON
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:HOWARD
Authorized Official - Last Name:HIRSCH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:516-735-8723
Mailing Address - Street 1:2870 HEMPSTEAD TPKE
Mailing Address - Street 2:
Mailing Address - City:LEVITTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11756-1341
Mailing Address - Country:US
Mailing Address - Phone:516-735-8723
Mailing Address - Fax:516-735-8444
Practice Address - Street 1:2870 HEMPSTEAD TPKE
Practice Address - Street 2:
Practice Address - City:LEVITTOWN
Practice Address - State:NY
Practice Address - Zip Code:11756-1341
Practice Address - Country:US
Practice Address - Phone:516-735-8723
Practice Address - Fax:516-735-8444
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-08
Last Update Date:2008-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0301871223P0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0106XDental ProvidersDentistOral and Maxillofacial PathologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYDCO5809W321Medicare ID - Type Unspecified
NY1548447493Medicare PIN
U44982Medicare UPIN