Provider Demographics
NPI:1528581584
Name:FUZAYLOV, EDUARD (TEACHER)
Entity Type:Individual
Prefix:
First Name:EDUARD
Middle Name:
Last Name:FUZAYLOV
Suffix:
Gender:M
Credentials:TEACHER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15015 79TH AVE APT 4A
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11367-3911
Mailing Address - Country:US
Mailing Address - Phone:646-270-6249
Mailing Address - Fax:
Practice Address - Street 1:15015 79TH AVE APT 4A
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11367-3911
Practice Address - Country:US
Practice Address - Phone:646-270-6249
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency