Provider Demographics
NPI:1548329972
Name:AUERBACH, SAMUEL (MD)
Entity type:Individual
Prefix:
First Name:SAMUEL
Middle Name:
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 1:2800 MARCUS AVE
Mailing Address - Street 2:
Mailing Address - City:NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11042-1113
Mailing Address - Country:US
Mailing Address - Phone:516-622-6000
Mailing Address - Fax:
Practice Address - Street 1:16030 VENTURA BLVD
Practice Address - Street 2:SIUTE #404
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-2731
Practice Address - Country:US
Practice Address - Phone:805-953-5848
Practice Address - Fax:718-273-4996
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-08
Last Update Date:2016-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV7617207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV002002825Medicaid
NV002002825Medicaid
NVV103820Medicare PIN