NPIMap

Organization Active NPI

Pain Medicine and Anesthesia PC

  • Pain Medicine (Anesthesiology) Physician
  • Franklin Lakes, NJ
National Provider Identifier
1386925394
Registry record updated Sep 2, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pain Medicine (Anesthesiology) PhysicianTaxonomy code 207LP2900X
License
25MB07566200 Issued in NJ
Legal business name
PAIN MEDICINE AND ANESTHESIA PC
Practice address
387 Vance Ave
Franklin Lakes, NJ 07417-3016
Phone
(201) 945-2900
NPI assigned
Sep 2, 2011
Last updated
Sep 2, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 2, 2011

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

Authorized official

Name
Dr. Roman Kosiborod, D.O.
Title
President
Phone
(201) 945-2900

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pain Medicine (Anesthesiology) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207LP2900X 25MB07566200 NJ Primary

Addresses

Primary practice location

387 Vance Ave
Franklin Lakes, NJ 07417-3016

Mailing address

387 Vance Ave
Franklin Lakes, NJ 07417-3016

National Provider Directory

National Provider Directory

Locations

17 Muhammad Ali Ave
Newark, NJ 07108
Phone (973) 679-6939

Practitioners & affiliated clinicians

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1314921600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1314921600000",
    "number": "1386925394",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "387 VANCE AVE",
            "city": "FRANKLIN LAKES",
            "state": "NJ",
            "postal_code": "074173016"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "387 VANCE AVE",
            "city": "FRANKLIN LAKES",
            "state": "NJ",
            "postal_code": "074173016",
            "telephone_number": "201-945-2900"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PAIN MEDICINE AND ANESTHESIA PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-09-02",
        "last_updated": "2011-09-02",
        "status": "A",
        "authorized_official_last_name": "KOSIBOROD",
        "authorized_official_first_name": "ROMAN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "201-945-2900",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.O."
    },
    "taxonomies": [
        {
            "code": "207LP2900X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Anesthesiology, Pain Medicine",
            "state": "NJ",
            "license": "25MB07566200",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Franklin Lakes, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 2, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.