Provider Demographics
NPI:1497868517
Name:HIRSCH, SUSAN BETH (PA)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:BETH
Last Name:HIRSCH
Suffix:
Gender:F
Credentials:PA
Other - Prefix:MRS
Other - First Name:SUSAN
Other - Middle Name:BETH
Other - Last Name:KLINE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:347 MOUNT PLEASANT AVE STE 205
Mailing Address - Street 2:THE DERMATOLOGY GROUP, PC
Mailing Address - City:WEST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07052-2749
Mailing Address - Country:US
Mailing Address - Phone:973-571-2121
Mailing Address - Fax:973-498-0512
Practice Address - Street 1:347 MOUNT PLEASANT AVE STE 205
Practice Address - Street 2:THE DERMATOLOGY GROUP, PC
Practice Address - City:WEST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07052-2749
Practice Address - Country:US
Practice Address - Phone:973-571-2121
Practice Address - Fax:973-498-0512
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2013-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009397-1207N00000X
NJ25MP001100500363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
P3595059OtherOXFORD