Healthcare Provider Details

I. General information

NPI: 1104741339
Provider Name (Legal Business Name): MR. TIMOTHY ANDREW HIRDT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2026
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 1ST AVE
NEW YORK NY
10016-6402
US

IV. Provider business mailing address

92 TALLMADGE TRL
MILLER PLACE NY
11764-2326
US

V. Phone/Fax

Practice location:
  • Phone: 212-263-6906
  • Fax:
Mailing address:
  • Phone: 631-951-8800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: