Alliance Spine Associates LLC

Primary specialty

Pain Medicine (Anesthesiology) PhysicianTaxonomy code 207LP2900X

License

25MB07566200 Issued in NJ

Legal business name

ALLIANCE SPINE ASSOCIATES LLC

Practice address

39-40 Broadway Ste 1
Fair Lawn, NJ 07410-5413

Phone

(201) 509-8998

Fax

(973) 246-7120

NPI assigned

Feb 6, 2014

Organization subpart

No

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

Authorized official

Name

Dr. Roman Kosiborod

Title

Specialist

Phone

(973) 685-7121

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1391644800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1555459200000",
    "number": "1922422237",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "39-40 BROADWAY STE 1",
            "city": "FAIR LAWN",
            "state": "NJ",
            "postal_code": "074105413",
            "telephone_number": "201-509-8998",
            "fax_number": "973-246-7120"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "39-40 BROADWAY STE 1",
            "city": "FAIR LAWN",
            "state": "NJ",
            "postal_code": "074105413",
            "telephone_number": "201-509-8998",
            "fax_number": "973-246-7120"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ALLIANCE SPINE ASSOCIATES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-02-06",
        "last_updated": "2019-04-17",
        "status": "A",
        "authorized_official_last_name": "KOSIBOROD",
        "authorized_official_first_name": "ROMAN",
        "authorized_official_title_or_position": "SPECIALIST",
        "authorized_official_telephone_number": "973-685-7121",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "207LP2900X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Anesthesiology, Pain Medicine",
            "state": "NJ",
            "license": "25MB07566200",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Pain Medicine (Anesthesiology) Physician in Fair Lawn, NJ
• Providers in Fair Lawn, NJ by specialty
• Pain Medicine (Anesthesiology) Physician in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 17, 2019; 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.