Provider Demographics
NPI:1245272889
Name:HIRSHMAN, HETTY J (APN)
Entity type:Individual
Prefix:
First Name:HETTY
Middle Name:J
Last Name:HIRSHMAN
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:DUMONT
Mailing Address - State:NJ
Mailing Address - Zip Code:07628-3004
Mailing Address - Country:US
Mailing Address - Phone:201-385-4400
Mailing Address - Fax:201-384-7067
Practice Address - Street 1:93 W PALISADE AVE
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07631-2611
Practice Address - Country:US
Practice Address - Phone:201-385-4400
Practice Address - Fax:201-384-7067
Is Sole Proprietor?:No
Enumeration Date:2006-06-11
Last Update Date:2008-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NC07473900363LP0808X, 364SP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ26NC07473900OtherLICENSE
NJQ47065Medicare UPIN
NJ092381BHDMedicare PIN