MEDICARE: DR. DMITRIY DVOSKIN M.D

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208100000X	Physical Medicine & Rehabilitation Physician	287516	NY
2	208VP0014X	Interventional Pain Medicine Physician	287516	NY
3	208100000X	Physical Medicine & Rehabilitation Physician	25MA10069200	NJ
4	208VP0014X	Interventional Pain Medicine Physician	25MA10069200	NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1518224583
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DMITRIY DVOSKIN M.D

Provider Business Mailing Address
First Line	:	90 MATAWAN RD STE 302
Second Line	:
City	:	MATAWAN
State	:	NJ
Zip	:	07747-2653
Country	:	US
Telephone Number	:	732-441-7177
Fax Number	:	732-441-7165

Provider Business Practice Location Address
First Line	:	8686 BAY PKWY STE M4
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11214-5193
Country	:	US
Telephone Number	:	718-265-7700
Fax Number	:	718-265-7701

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/16/2012
Last Update Date	:	01/21/2026

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