Individual
KONSTANTIN PERTSOVSKY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
510 HAMBURG TPKE, WAYNE COMMONS, SUITE 101, WAYNE, NJ 07470-2025
(973) 942-6005
(973) 942-6009
Mailing address
414 LAFAYETTE AVE, APT.A, CLIFFSIDE PARK, NJ 07010-2024
(201) 840-4081
(201) 840-4081
Taxonomy
Speciality
Code
Description
License number
State
204D00000X
Neuromusculoskeletal Medicine & OMM Physician
214845
NY
207Q00000X
Family Medicine Physician
214845
NY
207R00000X
Internal Medicine Physician
Primary
25MB07552900
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0157376
—
NJ
Enumeration date
07/03/2006
Last updated
11/06/2014
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