=====================================================
General NPI Number Information
=====================================================
NPI Number | 1346704939
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TRI CITY ACUPUNCTURE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/28/2019
-----------------------------------------------------
Last Update Date | 01/30/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 69 STATE ST FL 8
-----------------------------------------------------
City | ALBANY
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 12207-2504
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 518-487-1674
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1208 VINEYARD ST
-----------------------------------------------------
City | COHOES
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 12047-4858
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 518-487-1674
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DEBORAH FAHRBACH
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 518-487-1674
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 171100000X
-----------------------------------------------------
Taxonomy Name | Acupuncturist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------