Individual
BORIS FUZAYLOV
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
506 6TH ST, BROOKLYN, NY 11215-3609
(718) 780-3000
Mailing address
8821 63RD AVE, REGO PARK, NY 11374-2813
(718) 629-8172
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
019508
NY
Other
Enumeration date
02/17/2016
Last updated
04/11/2023
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