MEDICARE: DR. GAVRIEL FUZAYLOV MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	200199	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1154332310
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GAVRIEL FUZAYLOV MD

Provider Business Mailing Address
First Line	:	10210 66TH RD STE 1H
Second Line	:
City	:	FOREST HILLS
State	:	NY
Zip	:	11375-2047
Country	:	US
Telephone Number	:	718-897-0327
Fax Number	:	844-965-9107

Provider Business Practice Location Address
First Line	:	10210 66TH RD STE 1H
Second Line	:
City	:	FOREST HILLS
State	:	NY
Zip	:	11375-2047
Country	:	US
Telephone Number	:	718-897-0327
Fax Number	:	844-965-9107

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/11/2006
Last Update Date	:	07/05/2023

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