Provider Demographics
NPI:1326081506
Name:JONATHAN M. HIRSCH, MDPC
Entity Type:Organization
Organization Name:JONATHAN M. HIRSCH, MDPC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:MARTIN
Authorized Official - Last Name:HIRSCH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-376-5177
Mailing Address - Street 1:1861 E 22ND ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11229-1526
Mailing Address - Country:US
Mailing Address - Phone:718-376-5177
Mailing Address - Fax:718-376-1525
Practice Address - Street 1:2136 OCEAN AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229-1406
Practice Address - Country:US
Practice Address - Phone:718-376-5177
Practice Address - Fax:718-376-1525
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-14
Last Update Date:2012-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY182827207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
5301223OtherGHI
P1922953OtherOXFORD
HJ2827OtherATLANTIS
NY01435189Medicaid
182827B26OtherHEALTHFIRST
NY01435189Medicaid
F53977Medicare UPIN
NY6688300001Medicare NSC