Individual
DIANA FUZAILOV
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
27005 76TH AVE, NEW HYDE PARK, NY 11040-1402
(516) 470-7500
Mailing address
8253 167TH ST, JAMAICA, NY 11432-1822
(646) 299-8805
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
017849-1
NY
Other
Enumeration date
10/07/2014
Last updated
10/07/2014
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