Provider Demographics
NPI:1457122988
Name:HERSHKOP, MORDECHAI
Entity Type:Individual
Prefix:
First Name:MORDECHAI
Middle Name:
Last Name:HERSHKOP
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:46 SPRUCE ST
Mailing Address - Street 2:
Mailing Address - City:CEDARHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11516-2018
Mailing Address - Country:US
Mailing Address - Phone:917-579-3728
Mailing Address - Fax:
Practice Address - Street 1:46 SPRUCE ST
Practice Address - Street 2:
Practice Address - City:CEDARHURST
Practice Address - State:NY
Practice Address - Zip Code:11516-2018
Practice Address - Country:US
Practice Address - Phone:917-579-3728
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-12
Last Update Date:2024-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program