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General NPI Number Information
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NPI Number | 1104944685
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Entity Type | Individual
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Provider Name | OLEG FABRIKANT L. AC.
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Gender | Male
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Dates
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Enumeration Date | 03/26/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 19 W 21ST ST SUITE 904
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City | NEW YORK
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State | NY
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Zip | 10010-6805
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Country | US
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Telephone | 212-229-1220
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Fax |
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Provider Business Mailing Address
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Address Line | 30 WEST ST. APT. 17B
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City | NEW YORK
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State | NY
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Zip | 10004
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Country | US
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Telephone | 212-513-0670
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | 001973
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License Number State | NY
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