Provider Demographics
NPI:1679637110
Name:AUERBACH, JEFFREY KENNETH
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:KENNETH
Last Name:AUERBACH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19472 US ROUTE 11
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:13601-5387
Mailing Address - Country:US
Mailing Address - Phone:315-782-6126
Mailing Address - Fax:315-782-3816
Practice Address - Street 1:19472 US ROUTE 11
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:NY
Practice Address - Zip Code:13601-5387
Practice Address - Country:US
Practice Address - Phone:315-782-6126
Practice Address - Fax:315-782-3816
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY62028782174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty