Active NPI
Irina Fuzaylova, DDS
- Dentist
- Brooklyn, NY
National Provider Identifier
1720266380
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 052818
- Practice address
- 120 Nassau Ave
Brooklyn, NY 11222-4024 - Phone
- (718) 490-2846
- NPI assigned
- Feb 6, 2008
- Last updated
- Aug 24, 2009
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 052818 | NY | Primary |
Addresses
Primary practice location
120 Nassau Ave
Brooklyn, NY 11222-4024
Mailing address
6909 138TH St
Apt#2C
Flushing, NY 11367-1603
Phone (718) 490-2846
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NY
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20250411000513 | NY | Order and Referring Only - Dentist | 4880118843 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 052818 | NY | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Dental Care PLLC | Dentist | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Dentist
- Brooklyn, NY
- NPI 1609009786
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1202256000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1251072000000",
"number": "1720266380",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6909 138TH ST",
"address_2": "APT#2C",
"city": "FLUSHING",
"state": "NY",
"postal_code": "113671603",
"telephone_number": "718-490-2846"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "120 NASSAU AVE",
"city": "BROOKLYN",
"state": "NY",
"postal_code": "112224024",
"telephone_number": "718-490-2846"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FUZAYLOVA",
"first_name": "IRINA",
"credential": "DDS",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2008-02-06",
"last_updated": "2009-08-24",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "NY",
"license": "052818",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Brooklyn, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 24, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.