Provider Demographics
NPI:1639418999
Name:MITCHELL HIRSCH
Entity Type:Organization
Organization Name:MITCHELL HIRSCH
Other - Org Name:THE BRACESHOP LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MITCHELL
Authorized Official - Middle Name:S
Authorized Official - Last Name:HIRSCH
Authorized Official - Suffix:
Authorized Official - Credentials:CPO, LPO
Authorized Official - Phone:551-580-2305
Mailing Address - Street 1:37 MAGNOLIA AVE
Mailing Address - Street 2:
Mailing Address - City:TENAFLY
Mailing Address - State:NJ
Mailing Address - Zip Code:07670-2119
Mailing Address - Country:US
Mailing Address - Phone:551-580-2305
Mailing Address - Fax:877-331-3389
Practice Address - Street 1:37 MAGNOLIA AVE
Practice Address - Street 2:
Practice Address - City:TENAFLY
Practice Address - State:NJ
Practice Address - Zip Code:07670-2119
Practice Address - Country:US
Practice Address - Phone:551-580-2305
Practice Address - Fax:877-331-3389
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-06
Last Update Date:2017-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier