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Organization
PODIATRY DOCTOR PC
Active
Organization
PODIATRY DOCTOR PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
EMMANUAL FUZAYLOV DPM (MEDICAL DIRECTOR/PROVIDER)
(718) 618-6528
Entity
Organization
Contact information
Practice address
16110 JAMAICA AVE, JAMAICA, NY 11432-6139
(718) 618-6528
Mailing address
16110 JAMAICA AVE, JAMAICA, NY 11432-6139
Taxonomy
Speciality
Code
Description
License number
State
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
—
NULL
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
574772
THE JOINT COMMISSION
NY
Enumeration date
06/05/2018
Last updated
11/25/2024
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