Provider Demographics
NPI:1578333811
Name:KERD PAIN MANAGEMENT PRACTICE
Entity Type:Organization
Organization Name:KERD PAIN MANAGEMENT PRACTICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DMITRIY
Authorized Official - Middle Name:
Authorized Official - Last Name:DVOSKIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:347-228-1065
Mailing Address - Street 1:100 OLD PALISADE RD APT 3910
Mailing Address - Street 2:
Mailing Address - City:FORT LEE
Mailing Address - State:NJ
Mailing Address - Zip Code:07024-7029
Mailing Address - Country:US
Mailing Address - Phone:347-228-1065
Mailing Address - Fax:
Practice Address - Street 1:776 NORTHFIELD AVE STE 101
Practice Address - Street 2:
Practice Address - City:WEST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07052-1140
Practice Address - Country:US
Practice Address - Phone:347-228-1065
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-08
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty
No2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Multi-Specialty