Provider Demographics
NPI:1063558336
Name:FAIRPORT ACUPUNCTURE & WELLNESS, P.C.
Entity type:Organization
Organization Name:FAIRPORT ACUPUNCTURE & WELLNESS, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PENELOPE
Authorized Official - Middle Name:A
Authorized Official - Last Name:SOMERSET
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:585-381-8280
Mailing Address - Street 1:2130 FIVE MILE LINE RD
Mailing Address - Street 2:
Mailing Address - City:PENFIELD
Mailing Address - State:NY
Mailing Address - Zip Code:14526-2292
Mailing Address - Country:US
Mailing Address - Phone:585-381-8280
Mailing Address - Fax:
Practice Address - Street 1:2130 FIVE MILE LINE RD
Practice Address - Street 2:
Practice Address - City:PENFIELD
Practice Address - State:NY
Practice Address - Zip Code:14526-2292
Practice Address - Country:US
Practice Address - Phone:585-381-8280
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001292171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty