Provider Demographics
NPI:1821193186
Name:GOLDHIRSCH, MARK (DC)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:
Last Name:GOLDHIRSCH
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 550
Mailing Address - Street 2:
Mailing Address - City:PLEASANT VALLEY
Mailing Address - State:NY
Mailing Address - Zip Code:12569
Mailing Address - Country:US
Mailing Address - Phone:845-635-5002
Mailing Address - Fax:845-635-5295
Practice Address - Street 1:1395 RT 44
Practice Address - Street 2:
Practice Address - City:PLEASANT VALLEY
Practice Address - State:NY
Practice Address - Zip Code:12569
Practice Address - Country:US
Practice Address - Phone:845-635-5002
Practice Address - Fax:845-635-5295
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX0068561111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
U29852Medicare UPIN
X54131Medicare ID - Type Unspecified