Provider Demographics
NPI:1720037583
Name:AUERBACH, JEFFREY C (DO)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:C
Last Name:AUERBACH
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:906 PENNSYLVANIA AVE
Mailing Address - Street 2:
Mailing Address - City:MATAMORAS
Mailing Address - State:PA
Mailing Address - Zip Code:18336-1542
Mailing Address - Country:US
Mailing Address - Phone:570-491-4164
Mailing Address - Fax:570-491-5186
Practice Address - Street 1:906 PENNSYLVANIA AVE
Practice Address - Street 2:
Practice Address - City:MATAMORAS
Practice Address - State:PA
Practice Address - Zip Code:18336-1542
Practice Address - Country:US
Practice Address - Phone:570-491-4164
Practice Address - Fax:570-491-5186
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS004513L207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA37785Medicare ID - Type Unspecified
PAB80271Medicare UPIN
NY974061Medicare ID - Type Unspecified