Basic Information
| Provider Information | |||||||||
| NPI: | 1487610283 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HIRSH | ||||||||
| FirstName: | FREDRIC | ||||||||
| MiddleName: | M | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1150 YOUNGS RD | ||||||||
| Address2: | SUITE 104 | ||||||||
| City: | WILLIAMSVILLE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 142218053 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7166367979 | ||||||||
| FaxNumber: | 7166367993 | ||||||||
| Practice Location | |||||||||
| Address1: | 1150 YOUNGS RD | ||||||||
| Address2: | SUITE 104 | ||||||||
| City: | WILLIAMSVILLE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 142218053 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7166367979 | ||||||||
| FaxNumber: | 7166367993 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/21/2006 | ||||||||
| LastUpdateDate: | 02/18/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 120357 | NY | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 00637398 | 05 | NY | MEDICAID |