Provider Demographics
NPI:1144372095
Name:HIRSHAUT, YASHAR (MD)
Entity type:Individual
Prefix:DR
First Name:YASHAR
Middle Name:
Last Name:HIRSHAUT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:99 HARBOR VIEW WEST
Mailing Address - Street 2:
Mailing Address - City:LAURENCE
Mailing Address - State:NY
Mailing Address - Zip Code:11559
Mailing Address - Country:US
Mailing Address - Phone:516-371-0949
Mailing Address - Fax:212-628-8736
Practice Address - Street 1:860 FIFTH AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021
Practice Address - Country:US
Practice Address - Phone:212-861-1799
Practice Address - Fax:212-628-8736
Is Sole Proprietor?:No
Enumeration Date:2007-01-18
Last Update Date:2015-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY093077207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00923148Medicaid
NY273231Medicare ID - Type Unspecified
NY00923148Medicaid