Organization
INNOVATIVE REHABILITATION CONSULTANT MEDICAL PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DMITRIY FUZAYLOV MD (OWNDER)
(646) 784-3984
Entity
Organization
Contact information
Practice address
9701 66TH AVE, REGO PARK, NY 11374-4245
(718) 275-5200
Mailing address
21429 JAMAICA AVE, QUEENS VILLAGE, NY 11428-1733
Taxonomy
Speciality
Code
Description
License number
State
261QP3300X
Pain Clinic/Center
Primary
241269
NY
Other
Enumeration date
02/15/2011
Last updated
07/09/2021
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