Healthcare Provider Details

I. General information

NPI: 1407897622
Provider Name (Legal Business Name): FRED M AUERON M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2006
Last Update Date: 06/03/2025
Certification Date: 06/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

240 PATCHOGUE YAPHANK RD
EAST PATCHOGUE NY
11772-4868
US

IV. Provider business mailing address

240 PATCHOGUE YAPHANK RD STE 205
EAST PATCHOGUE NY
11772-4894
US

V. Phone/Fax

Practice location:
  • Phone: 631-824-4005
  • Fax:
Mailing address:
  • Phone: 631-654-7800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number319964
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number25MA04422800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: