Provider Demographics
NPI:1063707867
Name:SOMERSET, PENELOPE A (LAC)
Entity type:Individual
Prefix:
First Name:PENELOPE
Middle Name:A
Last Name:SOMERSET
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5126 SKINNER RD
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:NY
Mailing Address - Zip Code:14505-9564
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:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-09
Last Update Date:2011-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001292171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist