Provider Demographics
NPI:1104944685
Name:FABRIKANT, OLEG (L AC)
Entity type:Individual
Prefix:
First Name:OLEG
Middle Name:
Last Name:FABRIKANT
Suffix:
Gender:M
Credentials:L AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 WEST ST.
Mailing Address - Street 2:APT. 17B
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10004
Mailing Address - Country:US
Mailing Address - Phone:212-513-0670
Mailing Address - Fax:
Practice Address - Street 1:19 W 21ST ST
Practice Address - Street 2:SUITE 904
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10010-6805
Practice Address - Country:US
Practice Address - Phone:212-229-1220
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001973171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist