Provider Demographics
NPI:1396792636
Name:HIRDT, ALBERT P
Entity type:Individual
Prefix:
First Name:ALBERT
Middle Name:P
Last Name:HIRDT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:ALBERT
Other - Middle Name:P
Other - Last Name:HIRDT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:23 KAPROLET LN
Mailing Address - Street 2:
Mailing Address - City:WALDEN
Mailing Address - State:NY
Mailing Address - Zip Code:12586-2449
Mailing Address - Country:US
Mailing Address - Phone:845-566-0563
Mailing Address - Fax:845-566-0767
Practice Address - Street 1:23 KAPROLET LN
Practice Address - Street 2:
Practice Address - City:WALDEN
Practice Address - State:NY
Practice Address - Zip Code:12586-2449
Practice Address - Country:US
Practice Address - Phone:845-566-0563
Practice Address - Fax:845-566-0767
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-30
Last Update Date:2011-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY168541207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01136149Medicaid
NYE20366Medicare UPIN
NY01136149Medicaid