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General NPI Number Information
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NPI Number | 1215268669
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Entity Type | Organization
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Legal Business Name | REGO PARK MEDICAL ASSOCIATE,P.C
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Dates
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Enumeration Date | 01/26/2010
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Last Update Date | 07/05/2023
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Provider Practice Location Address
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Address Line | 9851 QUEENS BLVD SUITE 1D
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City | REGO PARK
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State | NY
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Zip | 11374-4362
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Country | US
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Telephone | 718-897-0327
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Fax | 718-897-0237
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Provider Business Mailing Address
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Address Line | 10210 66TH RD STE 1H
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City | FOREST HILLS
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State | NY
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Zip | 11375-2047
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Country | US
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Telephone | 718-897-0327
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Fax | 844-965-9107
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. GAVRIEL FUZAYLOV
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Credential | M D
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Telephone | 718-897-0327
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | 200199
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License Number State | NY
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