=====================================================
General NPI Number Information
=====================================================
NPI Number | 1437483732
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MARC DREW HIRSCHORN DDS
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/21/2009
-----------------------------------------------------
Last Update Date | 09/21/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10 OLD MAMARONECK RD SUITE # 1C
-----------------------------------------------------
City | WHITE PLAINS
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10605-1747
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 914-761-5505
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10 OLD MAMARONECK RD SUITE # 1C
-----------------------------------------------------
City | WHITE PLAINS
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10605-1747
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 914-761-5505
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223E0200X
-----------------------------------------------------
Taxonomy Name | Endodontics
-----------------------------------------------------
License Number | 035438
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------