Provider Demographics
NPI:1700072493
Name:HIRSCH, JONATHAN MARTIN (MD)
Entity type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:MARTIN
Last Name:HIRSCH
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 1:1861 E 22ND ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11229-1526
Mailing Address - Country:US
Mailing Address - Phone:718-376-5177
Mailing Address - Fax:718-376-1525
Practice Address - Street 1:2136 OCEAN AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229-1406
Practice Address - Country:US
Practice Address - Phone:718-376-5177
Practice Address - Fax:718-376-1525
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-17
Last Update Date:2007-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY182827-2207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
P1922953OtherOXFORD
NY01435189Medicaid
5301223OtherGHI
JH039H3220Medicare PIN