Individual
DR. RAFAEL FAZYLOV
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
5645 MAIN ST, RM M204, FLUSHING, NY 11355-5045
(718) 445-0220
(718) 939-1167
Mailing address
5645 MAIN ST, RM M204, FLUSHING, NY 11355-5045
(718) 445-0220
(718) 939-1167
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
240907
NY
Other
Enumeration date
12/19/2006
Last updated
07/08/2007
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