| NPI | 1891073029 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | YAKOV FUZAYLOV President 917-202-0190 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NY 055027) |
| Enumeration Date | 2011-07-21 |
| Last Update Date | 2011-07-21 |