Rego Park Medical Associate,P.C

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

License

200199 Issued in NY

Legal business name

REGO PARK MEDICAL ASSOCIATE,P.C

Practice address

9851 Queens Blvd
Suite 1D
Rego Park, NY 11374-4362

Phone

(718) 897-0327

Fax

(718) 897-0237

NPI assigned

Jan 26, 2010

Last updated

Jul 5, 2023By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Gavriel Fuzaylov, M DNPI 1154332310

Title

President

Phone

(718) 897-0327

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NY

Enrollment records 1

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Gavriel Fuzaylov, MD

  • Internal Medicine Physician
  • Forest Hills, NY
  • NPI 1154332310
  Medicare reassignment NPD Authorized official
• Raymond Malayev

  • Adult Health Nurse Practitioner
  • New York, NY
  • NPI 1851536684
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1264464000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1688515200000",
    "number": "1215268669",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10210 66TH RD STE 1H",
            "city": "FOREST HILLS",
            "state": "NY",
            "postal_code": "113752047",
            "telephone_number": "718-897-0327",
            "fax_number": "844-965-9107"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9851 QUEENS BLVD",
            "address_2": "SUITE 1D",
            "city": "REGO PARK",
            "state": "NY",
            "postal_code": "113744362",
            "telephone_number": "718-897-0327",
            "fax_number": "718-897-0237"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REGO PARK MEDICAL ASSOCIATE,P.C",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-01-26",
        "last_updated": "2023-07-05",
        "certification_date": "2023-07-05",
        "status": "A",
        "authorized_official_last_name": "FUZAYLOV",
        "authorized_official_first_name": "GAVRIEL",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "718-897-0327",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M D"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "NY",
            "license": "200199",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Rego Park Counseling LLC (Rego Park Mental Health Center)
• Rego Park Counseling LLC
• Rego Park Dental P.C.
• Rego Park Endo, LLC
• Rego Park Express Inc.
• Rego Park Medical Care, P.C.
• Rego Park Medical Services, P.C.
• Rego Park Optical Corp
• Rego Park Pharmacy LLC
• Rego Park Seniors Club LLC

• Primary Care Clinic/Center in Rego Park, NY
• Providers in Rego Park, NY by specialty
• Primary Care Clinic/Center in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 5, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.