Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | N005841 | NY |
Y | 222Z00000X | Podiatrist | N005841 | NY |
NPI | 1033281639 |
---|---|
Provider Name | Emmanuel Fuzaylov |
First Address | Forest Hills, NY 11375-2953 |
Second Address | Jamaica, NY 11432 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/11/2006 |
Last Update Date | 15/04/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U88654 | (02) |