Provider Demographics
NPI:1750431664
Name:AUERBACH, MARINA Y (MDPHD)
Entity type:Individual
Prefix:
First Name:MARINA
Middle Name:Y
Last Name:AUERBACH
Suffix:
Gender:F
Credentials:MDPHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 E 85TH ST APT 4A
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10028-0444
Mailing Address - Country:US
Mailing Address - Phone:212-249-0825
Mailing Address - Fax:
Practice Address - Street 1:18 E 77TH ST OFC B
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10075-1700
Practice Address - Country:US
Practice Address - Phone:917-701-6244
Practice Address - Fax:212-249-4116
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-11
Last Update Date:2012-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY212663-12084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYH14330Medicare UPIN