Provider Demographics
NPI:1881991412
Name:HIRSCH, GEDALIA ELI
Entity type:Individual
Prefix:
First Name:GEDALIA
Middle Name:ELI
Last Name:HIRSCH
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 1:1004 TWIN OAKS DR
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08701-7150
Mailing Address - Country:US
Mailing Address - Phone:732-961-7412
Mailing Address - Fax:
Practice Address - Street 1:1004 TWIN OAKS DRIVE
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08701-7150
Practice Address - Country:US
Practice Address - Phone:732-861-7412
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-02-17
Last Update Date:2011-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY046768183500000X
NJ28RI02567000183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist