Provider Demographics
NPI:1487820221
Name:HIRSCHHORN, PHILIP LON (DDS)
Entity Type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:LON
Last Name:HIRSCHHORN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:HICKSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11801-4266
Mailing Address - Country:US
Mailing Address - Phone:516-822-8700
Mailing Address - Fax:516-822-2396
Practice Address - Street 1:35 BROADWAY
Practice Address - Street 2:
Practice Address - City:HICKSVILLE
Practice Address - State:NY
Practice Address - Zip Code:11801-4266
Practice Address - Country:US
Practice Address - Phone:516-822-8700
Practice Address - Fax:516-822-2396
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-01
Last Update Date:2013-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY030684-11223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY030684-1OtherLICENSE