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General NPI Number Information
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NPI Number | 1922115054
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Entity Type | Individual
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Provider Name | SHOLOM MENASHE FUZAILOV DDS
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Gender | Male
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Dates
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Enumeration Date | 08/24/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 80 NORTH FRANKLIN STREET
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City | HEMPSTEAD
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State | NY
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Zip | 11550
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Country | US
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Telephone | 516-538-8980
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Fax | 516-538-8988
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Provider Business Mailing Address
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Address Line | 138-33 77 AVE
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City | FLUSHING
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State | NY
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Zip | 11367
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Country | US
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Telephone | 718-459-5362
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Fax | 718-459-5363
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 047661
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License Number State | NY
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