Provider Demographics
NPI:1356755730
Name:ELLIOT M. HIRSCH, M.D., INC.
Entity type:Organization
Organization Name:ELLIOT M. HIRSCH, M.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ELLIOT
Authorized Official - Middle Name:MATTHEW
Authorized Official - Last Name:HIRSCH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-825-8131
Mailing Address - Street 1:4419 VAN NUYS BLVD STE 214
Mailing Address - Street 2:
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91403-5718
Mailing Address - Country:US
Mailing Address - Phone:818-825-8131
Mailing Address - Fax:
Practice Address - Street 1:4419 VAN NUYS BLVD STE 214
Practice Address - Street 2:
Practice Address - City:SHERMAN OAKS
Practice Address - State:CA
Practice Address - Zip Code:91403-5718
Practice Address - Country:US
Practice Address - Phone:818-825-8131
Practice Address - Fax:818-616-1044
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-13
Last Update Date:2024-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA1298342086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Single Specialty