Provider Demographics
NPI:1548346307
Name:GLOBAL REHABILITATION MEDICAL PC
Entity type:Organization
Organization Name:GLOBAL REHABILITATION MEDICAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERVISING PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:OLEG
Authorized Official - Middle Name:
Authorized Official - Last Name:FUZAYLOV
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-275-5200
Mailing Address - Street 1:9701 66TH AVE
Mailing Address - Street 2:
Mailing Address - City:REGO PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11374-4245
Mailing Address - Country:US
Mailing Address - Phone:718-275-5200
Mailing Address - Fax:718-275-6864
Practice Address - Street 1:9701 66TH AVE
Practice Address - Street 2:
Practice Address - City:REGO PARK
Practice Address - State:NY
Practice Address - Zip Code:11374-4245
Practice Address - Country:US
Practice Address - Phone:718-275-5200
Practice Address - Fax:718-275-6864
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-27
Last Update Date:2007-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02655154Medicaid
NY02655154Medicaid