Provider Demographics
NPI:1881657914
Name:HIRSCH, HENRY
Entity Type:Individual
Prefix:DR
First Name:HENRY
Middle Name:
Last Name:HIRSCH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:410 EAST HALLANDALE BEACH BLVD
Mailing Address - Street 2:CHEN MEDICAL HALLANDALE, INC
Mailing Address - City:HALLANDALE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33009-5584
Mailing Address - Country:US
Mailing Address - Phone:954-454-5777
Mailing Address - Fax:954-924-0812
Practice Address - Street 1:410 EAST HALLANDALE BEACH BLVD
Practice Address - Street 2:CHEN MEDICAL HALLANDALE, INC
Practice Address - City:HALLANDALE BEACH
Practice Address - State:FL
Practice Address - Zip Code:33009-5584
Practice Address - Country:US
Practice Address - Phone:954-454-5777
Practice Address - Fax:954-924-0812
Is Sole Proprietor?:No
Enumeration Date:2006-04-10
Last Update Date:2016-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0019262207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL055553300Medicaid
FLD58174Medicare UPIN
FL71749RMedicare ID - Type Unspecified