Provider Demographics
NPI:1083618607
Name:AUERBACH, MITCHELL EVAN (MD)
Entity Type:Individual
Prefix:DR
First Name:MITCHELL
Middle Name:EVAN
Last Name:AUERBACH
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 1:469 N BROADWAY
Mailing Address - Street 2:
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10701-1923
Mailing Address - Country:US
Mailing Address - Phone:914-969-1115
Mailing Address - Fax:914-968-0402
Practice Address - Street 1:469 N BROADWAY
Practice Address - Street 2:
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10701-1923
Practice Address - Country:US
Practice Address - Phone:914-969-1115
Practice Address - Fax:914-968-0402
Is Sole Proprietor?:No
Enumeration Date:2005-06-10
Last Update Date:2008-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY191381207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
G23596Medicare UPIN
NY02N61EZ911Medicare PIN