Provider Demographics
NPI:1972745065
Name:HIRSCH, RANDALL JOEL (MD)
Entity Type:Individual
Prefix:DR
First Name:RANDALL
Middle Name:JOEL
Last Name:HIRSCH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:245 E 19TH ST
Mailing Address - Street 2:2M
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10003-2639
Mailing Address - Country:US
Mailing Address - Phone:773-935-9163
Mailing Address - Fax:
Practice Address - Street 1:245 E 19TH ST
Practice Address - Street 2:2M
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-2639
Practice Address - Country:US
Practice Address - Phone:773-935-9163
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-03
Last Update Date:2009-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY247645208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice