MEDICARE: DR. CARY LESLIE HIRSCH MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RI0011X	Interventional Cardiology Physician	143341-1	NY
2	207RI0011X	Interventional Cardiology Physician	25MA05142900	NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1215965298
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CARY LESLIE HIRSCH MD

Provider Business Mailing Address
First Line	:	20 GRAND STREET
Second Line	:	3RD FLOOR
City	:	WARWICK
State	:	NY
Zip	:	10990-1035
Country	:	US
Telephone Number	:	845-987-3901
Fax Number	:	845-987-5979

Provider Business Practice Location Address
First Line	:	257 LAFAYETTE AVE
Second Line	:	SUITE 300
City	:	SUFFERN
State	:	NY
Zip	:	10901-4830
Country	:	US
Telephone Number	:	845-368-0330
Fax Number	:	845-368-8143

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/29/2006
Last Update Date	:	07/03/2018

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