Provider Demographics
NPI:1881876811
Name:HIRSCH, MARK STUART (DDS)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:STUART
Last Name:HIRSCH
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 E ECKERSON RD
Mailing Address - Street 2:SUITE 2-3
Mailing Address - City:NEW CITY
Mailing Address - State:NY
Mailing Address - Zip Code:10956-7153
Mailing Address - Country:US
Mailing Address - Phone:845-356-4484
Mailing Address - Fax:845-358-7234
Practice Address - Street 1:200 E ECKERSON RD
Practice Address - Street 2:SUITE 2-3
Practice Address - City:NEW CITY
Practice Address - State:NY
Practice Address - Zip Code:10956-7153
Practice Address - Country:US
Practice Address - Phone:845-356-4484
Practice Address - Fax:845-358-7234
Is Sole Proprietor?:No
Enumeration Date:2007-11-30
Last Update Date:2007-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY032989-11223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice