MEDICARE: RENI FAIRMAN L.AC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171100000X	Acupuncturist	005761	NY

General Provider Information

NPI Number	:	1962958645
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RENI FAIRMAN L.AC

Provider Business Mailing Address
First Line	:	123 N HOOPES AVE
Second Line	:
City	:	AUBURN
State	:	NY
Zip	:	13021-2905
Country	:	US
Telephone Number	:	315-246-0177
Fax Number	:

Provider Business Practice Location Address
First Line	:	33 WILLIAM ST STE 8A
Second Line	:
City	:	AUBURN
State	:	NY
Zip	:	13021-3730
Country	:	US
Telephone Number	:	315-246-0177
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/31/2016
Last Update Date	:	12/12/2023

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Directions to “ RENI FAIRMAN L.AC” Practice Location

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