Healthcare Provider Details

I. General information

NPI: 1720137128
Provider Name (Legal Business Name): LARISSA J HIRSCH MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/09/2007
Last Update Date: 11/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 E 68TH ST HT 506, BOX 120
NEW YORK NY
10065-4870
US

IV. Provider business mailing address

525 E 68TH ST HT 506, BOX 120
NEW YORK NY
10065-4870
US

V. Phone/Fax

Practice location:
  • Phone: 212-746-3320
  • Fax:
Mailing address:
  • Phone: 212-746-3320
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD428559
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number231703
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: