Provider Demographics
NPI:1811288442
Name:ALBERT P HIRDT DO PC
Entity type:Organization
Organization Name:ALBERT P HIRDT DO PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALBERT
Authorized Official - Middle Name:P
Authorized Official - Last Name:HIRDT
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:845-566-0563
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:
Mailing Address - Fax:845-566-0767
Practice Address - Street 1:4 VICTORY CT
Practice Address - Street 2:
Practice Address - City:NEWBURGH
Practice Address - State:NY
Practice Address - Zip Code:12550-1745
Practice Address - Country:US
Practice Address - Phone:845-565-9886
Practice Address - Fax:845-565-7084
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-30
Last Update Date:2012-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY168541261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
A100061156Medicare UPIN