1548489545 NPI number — DR. JASON PHILIP HIRSCH DMD MPH

Table of content: DR. JASON PHILIP HIRSCH DMD MPH (NPI 1548489545)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548489545 NPI number — DR. JASON PHILIP HIRSCH DMD MPH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HIRSCH
Provider First Name:
JASON
Provider Middle Name:
PHILIP
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DMD MPH
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1548489545
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/04/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8992 LITTLE FALLS WAY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DELRAY BEACH
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33446-9592
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
954-242-6181
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
685 ROYAL PALM BEACH BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ROYAL PALM BEACH
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33411-7642
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
561-795-7959
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/25/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1223P0221X , with the licence number:  DN 15983 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)