Provider Demographics
NPI:1699885483
Name:HERSH, SHELDON PAUL (MD)
Entity type:Individual
Prefix:
First Name:SHELDON
Middle Name:PAUL
Last Name:HERSH
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 1:11011 72ND AVE
Mailing Address - Street 2:SUITE 1B
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-4946
Mailing Address - Country:US
Mailing Address - Phone:718-261-9000
Mailing Address - Fax:718-268-0504
Practice Address - Street 1:11011 72ND AVE
Practice Address - Street 2:SUITE 1B
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-4946
Practice Address - Country:US
Practice Address - Phone:718-261-9000
Practice Address - Fax:718-268-0504
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY138505207YX0905X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YX0905XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngology/Facial Plastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00744234Medicaid
NY00744234Medicaid
71A872Medicare ID - Type Unspecified