Basic Information
| Provider Information | |||||||||
| NPI: | 1881657914 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HIRSCH | ||||||||
| FirstName: | HENRY | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 410 EAST HALLANDALE BEACH BLVD | ||||||||
| Address2: | CHEN MEDICAL HALLANDALE, INC | ||||||||
| City: | HALLANDALE BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 330095584 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9544545777 | ||||||||
| FaxNumber: | 9549240812 | ||||||||
| Practice Location | |||||||||
| Address1: | 410 EAST HALLANDALE BEACH BLVD | ||||||||
| Address2: | CHEN MEDICAL HALLANDALE, INC | ||||||||
| City: | HALLANDALE BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 330095584 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9544545777 | ||||||||
| FaxNumber: | 9549240812 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/10/2006 | ||||||||
| LastUpdateDate: | 01/15/2016 | ||||||||
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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 | 207RC0000X | ME0019262 | FL | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
ID Information
| ID | Type | State | Issuer | Description | 055553300 | 05 | FL | MEDICAID |