Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Innovative Rehabilitation Consultant Medical PC

Organization Pain Clinic/Center · NPI 1770880403

Innovative Rehabilitation Consultant Medical PC is a Pain Clinic/Center in Rego Park, New York. Licensed in New York. Registered with an NPI since 2011.

Licensed in
NY
In the registry since
2011
What do these letters mean?
PC — Professional corporation
A form of business registration, not a clinical qualification.

See every abbreviation used in this directory →

Practice location Address checks out

9701 66th Ave
Rego Park, NY 11374-4245
Phone: (718) 275-5200
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Pain Clinic/Center (primary) Taxonomy 261QP3300X · Licence 241269 (NY)

Record details

NPI number1770880403
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Dmitriy Fuzaylov — Ownder · (646) 784-3984
NPI enumeratedFebruary 15, 2011
Last updated in NPPESJuly 9, 2021
Certification dateJuly 9, 2021
Mailing address21429 Jamaica Ave, Queens Village, NY 11428-1733