Provider Demographics
NPI:1053371450
Name:LADUCA, JEFFREY ROBERT (PH D, MD)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:ROBERT
Last Name:LADUCA
Suffix:
Gender:M
Credentials:PH D, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:144 STANDART AVE
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:NY
Mailing Address - Zip Code:13021-1508
Mailing Address - Country:US
Mailing Address - Phone:315-255-1100
Mailing Address - Fax:
Practice Address - Street 1:144 STANDART AVE
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:NY
Practice Address - Zip Code:13021-1508
Practice Address - Country:US
Practice Address - Phone:315-255-1100
Practice Address - Fax:315-255-1322
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-28
Last Update Date:2024-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY214949-1174400000X
NY214949207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02309960Medicaid
NY02309960Medicaid
NYH56198Medicare UPIN