Provider Demographics
NPI:1063849545
Name:HIRSCH, LISA NICOLE (MD)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:NICOLE
Last Name:HIRSCH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:20 GRAND STREET, 3RD FL
Mailing Address - Street 2:
Mailing Address - City:WARWICK
Mailing Address - State:NY
Mailing Address - Zip Code:10990-1035
Mailing Address - Country:US
Mailing Address - Phone:845-987-3901
Mailing Address - Fax:845-987-5979
Practice Address - Street 1:234 E 149TH ST
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10451-5504
Practice Address - Country:US
Practice Address - Phone:718-579-5874
Practice Address - Fax:718-579-4836
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-30
Last Update Date:2016-07-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
282N00000X
NY285675207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No282N00000XHospitalsGeneral Acute Care Hospital