Provider Demographics
NPI:1184628729
Name:HIRSCH, ROBERT
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:
Last Name:HIRSCH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:870 PALISADE AVE
Mailing Address - Street 2:
Mailing Address - City:TEANECK
Mailing Address - State:NJ
Mailing Address - Zip Code:07666-3419
Mailing Address - Country:US
Mailing Address - Phone:201-907-0900
Mailing Address - Fax:201-907-0229
Practice Address - Street 1:870 PALISADE AVE
Practice Address - Street 2:
Practice Address - City:TEANECK
Practice Address - State:NJ
Practice Address - Zip Code:07666-3419
Practice Address - Country:US
Practice Address - Phone:201-907-0900
Practice Address - Fax:201-907-0229
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-10
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA01906600174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1K4682OtherHEALTHNET ID #
NJ902211OtherEMPIRE BC/BS #
NJ1071171OtherHORIZON NJ HEALTH #
NJ1273001Medicaid
NJ4231739OtherAETNA PPO #
NJ0087548OtherGHI PPO #
NJP1975158OtherOXFORD PROVIDER #
NJ2274523OtherAETNA HMO #
NJ1273001Medicaid
NJ902211OtherEMPIRE BC/BS #