Provider Demographics
NPI:1275800062
Name:FOZIL, ADA ADINA
Entity Type:Individual
Prefix:
First Name:ADA
Middle Name:ADINA
Last Name:FOZIL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9941 64TH AVE APT C7
Mailing Address - Street 2:
Mailing Address - City:REGO PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11374-2670
Mailing Address - Country:US
Mailing Address - Phone:646-361-1477
Mailing Address - Fax:
Practice Address - Street 1:9941 64TH AVE APT C7
Practice Address - Street 2:
Practice Address - City:REGO PARK
Practice Address - State:NY
Practice Address - Zip Code:11374-2670
Practice Address - Country:US
Practice Address - Phone:646-361-1477
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-21
Last Update Date:2011-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1383558101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health