Provider Demographics
NPI:1134482136
Name:HIRSH, FRED (DMD)
Entity Type:Individual
Prefix:DR
First Name:FRED
Middle Name:
Last Name:HIRSH
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:999 CENTRAL AVE
Mailing Address - Street 2:300
Mailing Address - City:WOODMERE
Mailing Address - State:NY
Mailing Address - Zip Code:11598
Mailing Address - Country:US
Mailing Address - Phone:516-569-0110
Mailing Address - Fax:516-569-4088
Practice Address - Street 1:999 CENTRAL AVE
Practice Address - Street 2:300
Practice Address - City:WOODMERE
Practice Address - State:NY
Practice Address - Zip Code:11598
Practice Address - Country:US
Practice Address - Phone:516-569-0110
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-25
Last Update Date:2012-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY028842122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist