Healthcare Provider Details

I. General information

NPI: 1275497018
Provider Name (Legal Business Name): ROMAN NP IN FAMILY HEALTH PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/15/2025
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9934 65TH AVE
REGO PARK NY
11374-3653
US

IV. Provider business mailing address

9934 65TH AVE
REGO PARK NY
11374-3653
US

V. Phone/Fax

Practice location:
  • Phone: 646-508-3644
  • Fax:
Mailing address:
  • Phone: 646-508-3644
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: ROMAN FAYZIBAYEV
Title or Position: FAMILY NURSE PRACTITIONER
Credential: FNP
Phone: 646-508-3644