# PODIATRY DOCTOR PC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1306338371
- **Authorized official:** EMMANUAL FUZAYLOV DPM (MEDICAL DIRECTOR/PROVIDER)
- **Authorized official phone:** (718) 618-6528

## Contact information

- **Practice address:** 16110 JAMAICA AVE, JAMAICA, NY 11432-6139
- **Practice address phone:** (718) 618-6528
- **Mailing address:** 16110 JAMAICA AVE, JAMAICA, NY 11432-6139

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 213ES0103X | Foot & Ankle Surgery Podiatrist | — | NULL | Yes |
| 213ES0103X | Foot & Ankle Surgery Podiatrist | — | — | Yes |

## Other

- **Enumeration date:** 06/05/2018
- **Last updated:** 11/25/2024

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 574772 | THE JOINT COMMISSION | NY |