MEDICARE: DR. JONATHAN MARTIN 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	207LP2900X	Pain Medicine (Anesthesiology) Physician	182827-2	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	P1922953	OTHER	OXFORD
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	5301223	OTHER	GHI

General Provider Information

NPI Number	:	1700072493
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JONATHAN MARTIN HIRSCH MD

Provider Business Mailing Address
First Line	:	1861 E 22ND ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11229-1526
Country	:	US
Telephone Number	:	718-376-5177
Fax Number	:	718-376-1525

Provider Business Practice Location Address
First Line	:	2136 OCEAN AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11229-1406
Country	:	US
Telephone Number	:	718-376-5177
Fax Number	:	718-376-1525

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

Provider Enumeration Date	:	09/17/2007
Last Update Date	:	09/17/2007

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