Provider Demographics
NPI:1508309550
Name:AUERBACH, SETH (MBA)
Entity Type:Individual
Prefix:
First Name:SETH
Middle Name:
Last Name:AUERBACH
Suffix:
Gender:M
Credentials:MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:424 N WHITE HORSE PIKE
Mailing Address - Street 2:
Mailing Address - City:MAGNOLIA
Mailing Address - State:NJ
Mailing Address - Zip Code:08049-1405
Mailing Address - Country:US
Mailing Address - Phone:856-240-5001
Mailing Address - Fax:856-854-5204
Practice Address - Street 1:230 W WASHINGTON SQ
Practice Address - Street 2:5TH FLOOR
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19106-3585
Practice Address - Country:US
Practice Address - Phone:215-829-6955
Practice Address - Fax:215-829-6899
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-23
Last Update Date:2016-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ0075846332B00000X, 335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3354407Medicaid
NJ0452610001Medicare NSC