Provider Demographics
NPI:1215268669
Name:REGO PARK MEDICAL ASSOCIATE,P.C
Entity type:Organization
Organization Name:REGO PARK MEDICAL ASSOCIATE,P.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GAVRIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:FUZAYLOV
Authorized Official - Suffix:
Authorized Official - Credentials:M D
Authorized Official - Phone:718-897-0327
Mailing Address - Street 1:10210 66TH RD STE 1H
Mailing Address - Street 2:
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-2047
Mailing Address - Country:US
Mailing Address - Phone:718-897-0327
Mailing Address - Fax:844-965-9107
Practice Address - Street 1:9851 QUEENS BLVD
Practice Address - Street 2:SUITE 1D
Practice Address - City:REGO PARK
Practice Address - State:NY
Practice Address - Zip Code:11374-4362
Practice Address - Country:US
Practice Address - Phone:718-897-0327
Practice Address - Fax:718-897-0237
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-26
Last Update Date:2023-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY200199261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care