Provider Demographics
NPI:1396869335
Name:HIRSCH, BENJAMIN (PHD)
Entity type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:
Last Name:HIRSCH
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1369 N JERUSALEM RD
Mailing Address - Street 2:
Mailing Address - City:EAST MEADOW
Mailing Address - State:NY
Mailing Address - Zip Code:11554-4538
Mailing Address - Country:US
Mailing Address - Phone:516-485-4080
Mailing Address - Fax:516-485-4081
Practice Address - Street 1:1369 N JERUSALEM RD
Practice Address - Street 2:
Practice Address - City:EAST MEADOW
Practice Address - State:NY
Practice Address - Zip Code:11554-4538
Practice Address - Country:US
Practice Address - Phone:516-485-4080
Practice Address - Fax:516-485-4081
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY4033103G00000X, 103TC0700X, 103T00000X
103T00000X, 103TA0700X, 103TB0200X, 103TC2200X, 103TF0000X, 103TF0200X, 103TR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist
Not Answered103TA0700XBehavioral Health & Social Service ProvidersPsychologistAdult Development & Aging
Not Answered103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Not Answered103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
Not Answered103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamily
Not Answered103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic
Not Answered103TR0400XBehavioral Health & Social Service ProvidersPsychologistRehabilitation