Provider Demographics
NPI:1578793139
Name:HIRSCH, MITCHELL S (CPO,LPO)
Entity Type:Individual
Prefix:MR
First Name:MITCHELL
Middle Name:S
Last Name:HIRSCH
Suffix:
Gender:M
Credentials:CPO,LPO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:73 HIGHWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:TENAFLY
Mailing Address - State:NJ
Mailing Address - Zip Code:07670-1835
Mailing Address - Country:US
Mailing Address - Phone:551-580-2305
Mailing Address - Fax:877-331-3389
Practice Address - Street 1:73 HIGHWOOD AVE
Practice Address - Street 2:
Practice Address - City:TENAFLY
Practice Address - State:NJ
Practice Address - Zip Code:07670-1835
Practice Address - Country:US
Practice Address - Phone:551-580-2305
Practice Address - Fax:877-331-3389
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-16
Last Update Date:2013-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJCPO01729335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier