Provider Demographics
NPI:1922004985
Name:HIRSH, S JAY (MD)
Entity Type:Individual
Prefix:DR
First Name:S
Middle Name:JAY
Last Name:HIRSH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1248 MIDDLETOWN RD
Mailing Address - Street 2:
Mailing Address - City:GLEN MILLS
Mailing Address - State:PA
Mailing Address - Zip Code:19342-9661
Mailing Address - Country:US
Mailing Address - Phone:610-874-6580
Mailing Address - Fax:610-874-5504
Practice Address - Street 1:30 MEDICAL CENTER BLVD
Practice Address - Street 2:STE 102
Practice Address - City:UPLAND
Practice Address - State:PA
Practice Address - Zip Code:19013-3955
Practice Address - Country:US
Practice Address - Phone:610-874-6580
Practice Address - Fax:610-874-5504
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-24
Last Update Date:2008-06-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD12694E208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA000872255Medicaid
PA000872255Medicaid
PAE55435Medicare UPIN
PA0760160001Medicare NSC