Provider Demographics
NPI:1366105868
Name:NYS MEDICAL CARE, P.C.
Entity type:Organization
Organization Name:NYS MEDICAL CARE, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SVETLANA
Authorized Official - Middle Name:
Authorized Official - Last Name:FUZAYLOVA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-986-7774
Mailing Address - Street 1:51 FIELD LN
Mailing Address - Street 2:
Mailing Address - City:ROSLYN HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11577-2605
Mailing Address - Country:US
Mailing Address - Phone:718-986-7774
Mailing Address - Fax:
Practice Address - Street 1:9218 165TH ST
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11433-1104
Practice Address - Country:US
Practice Address - Phone:718-725-0044
Practice Address - Fax:718-725-0880
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-21
Last Update Date:2021-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01987957Medicaid