Provider Demographics
NPI:1184643504
Name:AUERBACH, KARL (MD)
Entity type:Individual
Prefix:DR
First Name:KARL
Middle Name:
Last Name:AUERBACH
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:94 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:TICONDEROGA
Mailing Address - State:NY
Mailing Address - Zip Code:12883-1100
Mailing Address - Country:US
Mailing Address - Phone:585-721-6699
Mailing Address - Fax:
Practice Address - Street 1:94 PARK AVE
Practice Address - Street 2:
Practice Address - City:TICONDEROGA
Practice Address - State:NY
Practice Address - Zip Code:12883-1100
Practice Address - Country:US
Practice Address - Phone:585-721-6699
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2025-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1319342083X0100X, 2083P0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0500XAllopathic & Osteopathic PhysiciansPreventive MedicinePreventive Medicine/Occupational Environmental Medicine
No2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01196496Medicaid
NYCC9739Medicare PIN
NY01196496Medicaid