Provider Demographics
NPI:1912225905
Name:FUZAYLOVA, TAMARA (PA)
Entity Type:Individual
Prefix:
First Name:TAMARA
Middle Name:
Last Name:FUZAYLOVA
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10245 62ND RD APT 4K
Mailing Address - Street 2:
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-1019
Mailing Address - Country:US
Mailing Address - Phone:718-607-1009
Mailing Address - Fax:
Practice Address - Street 1:10245 62ND RD APT 4K
Practice Address - Street 2:
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-1019
Practice Address - Country:US
Practice Address - Phone:718-607-1009
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-14
Last Update Date:2010-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013923-1146M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146M00000XEmergency Medical Service ProvidersEmergency Medical Technician, Intermediate