Petrychenko Pain Management PA

Primary specialty

Pain Medicine (Anesthesiology) PhysicianTaxonomy code 207LP2900X

Legal business name

PETRYCHENKO PAIN MANAGEMENT PA

Practice address

2100 E Hallandale Beach Blvd Ste 210
Hallandale Beach, FL 33009-3770

Phone

(212) 951-1238

Fax

(718) 336-5137

NPI assigned

Jun 28, 2021

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Dmitri Petrychenko, MDNPI 1588644272

Title

President

Phone

(929) 320-7481

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Dmitri Petrychenko, M.D.

  • Interventional Pain Medicine Physician
  • Brooklyn, NY
  • NPI 1588644272

  FL, Specialist

  Medicare reassignment NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1624838400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1624838400000",
    "number": "1841860442",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2100 E HALLANDALE BEACH BLVD STE 210",
            "city": "HALLANDALE BEACH",
            "state": "FL",
            "postal_code": "330093770",
            "telephone_number": "212-951-1238",
            "fax_number": "718-336-5137"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2100 E HALLANDALE BEACH BLVD STE 210",
            "city": "HALLANDALE BEACH",
            "state": "FL",
            "postal_code": "330093770",
            "telephone_number": "212-951-1238",
            "fax_number": "718-336-5137"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PETRYCHENKO PAIN MANAGEMENT PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-06-28",
        "last_updated": "2021-06-28",
        "certification_date": "2021-06-24",
        "status": "A",
        "authorized_official_last_name": "PETRYCHENKO",
        "authorized_official_first_name": "DMITRI",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "929-320-7481",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Specialist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207LP2900X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Anesthesiology, Pain Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Gerardo Perez-Garcia, MSN., RN., FNP-BC
• Alba Lucia Perez, AP,MM, NC, CC
• Jesslyn Perez, APRN, FNP-BC
• Personal Physician Management Group of Hallandale, Inc.
• Peter Tomasello D O P a
• Elizabeth Pfeffer
• Pharmacy Doctors Enterprises
• Pharmacy Doctors Enterprises Inc
• Pharmacy Express & Discount Corp
• Pharmacy Express & Discount Corp

• Pain Medicine (Anesthesiology) Physician in Hallandale Beach, FL
• Providers in Hallandale Beach, FL by specialty
• Pain Medicine (Anesthesiology) Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 28, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.