Provider Demographics
NPI:1063497360
Name:HIRSCHHORN, PETER J (DPM)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:J
Last Name:HIRSCHHORN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 273
Mailing Address - Street 2:
Mailing Address - City:JERICHO
Mailing Address - State:NY
Mailing Address - Zip Code:11753-0273
Mailing Address - Country:US
Mailing Address - Phone:718-652-2099
Mailing Address - Fax:718-519-1140
Practice Address - Street 1:15 E 208TH ST
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10467-2727
Practice Address - Country:US
Practice Address - Phone:718-652-2099
Practice Address - Fax:718-519-1140
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-08
Last Update Date:2011-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003341213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00659090Medicaid
GAP00292966OtherRAILROAD MEDICARE
NYP35041Medicare PIN
GAP00292966OtherRAILROAD MEDICARE