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General NPI Number Information
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NPI Number | 1972618296
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Entity Type | Individual
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Provider Name | KENNETH A HIRSCH MD
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Gender | Male
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Dates
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Enumeration Date | 08/19/2006
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Last Update Date | 03/13/2008
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Provider Practice Location Address
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Address Line | 75 N COUNTRY RD
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City | PORT JEFFERSON
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State | NY
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Zip | 11777-2119
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Country | US
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Telephone | 631-476-2808
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Fax |
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Provider Business Mailing Address
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Address Line | 107 OLD FIELD RD
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City | SETAUKET
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State | NY
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Zip | 11733-1639
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207PE0004X
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Taxonomy Name | Emergency Medical Services (Emergency Medicine) Physician
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License Number | 148992
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 207PE0005X
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Taxonomy Name | Undersea and Hyperbaric Medicine (Emergency Medicine) Physician
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License Number | 148992
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License Number State | NY
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