Healthcare Provider Details

I. General information

NPI: 1396792636
Provider Name (Legal Business Name): ALBERT P HIRDT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: ALBERT P HIRDT DO

II. Dates (important events)

Enumeration Date: 05/30/2006
Last Update Date: 04/29/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23 KAPROLET LN
WALDEN NY
12586-2449
US

IV. Provider business mailing address

23 KAPROLET LN
WALDEN NY
12586-2449
US

V. Phone/Fax

Practice location:
  • Phone: 845-566-0563
  • Fax: 845-566-0767
Mailing address:
  • Phone: 845-566-0563
  • Fax: 845-566-0767

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number168541
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: