Healthcare Provider Details

I. General information

NPI: 1548346307
Provider Name (Legal Business Name): GLOBAL REHABILITATION MEDICAL PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/27/2006
Last Update Date: 09/05/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9701 66TH AVE
REGO PARK NY
11374-4245
US

IV. Provider business mailing address

9701 66TH AVE
REGO PARK NY
11374-4245
US

V. Phone/Fax

Practice location:
  • Phone: 718-275-5200
  • Fax: 718-275-6864
Mailing address:
  • Phone: 718-275-5200
  • Fax: 718-275-6864

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. OLEG FUZAYLOV
Title or Position: SUPERVISING PHYSICIAN
Credential: MD
Phone: 718-275-5200