Basic Information
| Provider Information | |||||||||
| NPI: | 1144219346 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HIRSCH | ||||||||
| FirstName: | JORDAN | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 73 MARKET ST | ||||||||
| Address2: | SUITE 212 B | ||||||||
| City: | YONKERS | ||||||||
| State: | NY | ||||||||
| PostalCode: | 107107602 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9148316830 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 73 MARKET ST | ||||||||
| Address2: | SUITE 212 B | ||||||||
| City: | YONKERS | ||||||||
| State: | NY | ||||||||
| PostalCode: | 107107602 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9148316830 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/19/2005 | ||||||||
| LastUpdateDate: | 03/04/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/04/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | 172513 | NY | N | Other Service Providers | Specialist | 207V00000X | 172513 | NY | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 01849045 | 05 | NY | MEDICAID |