Provider Demographics
NPI:1275786816
Name:MIDLAND ANESTHESIA AND PAIN MANAGEMENT, PC
Entity Type:Organization
Organization Name:MIDLAND ANESTHESIA AND PAIN MANAGEMENT, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ROMAN
Authorized Official - Middle Name:
Authorized Official - Last Name:KOSIBOROD
Authorized Official - Suffix:
Authorized Official - Credentials:MD, DO
Authorized Official - Phone:973-685-7121
Mailing Address - Street 1:PO BOX 8084
Mailing Address - Street 2:
Mailing Address - City:SADDLE BROOK
Mailing Address - State:NJ
Mailing Address - Zip Code:07663-8084
Mailing Address - Country:US
Mailing Address - Phone:973-685-7121
Mailing Address - Fax:973-246-7120
Practice Address - Street 1:190 MIDLAND AVE
Practice Address - Street 2:
Practice Address - City:SADDLE BROOK
Practice Address - State:NJ
Practice Address - Zip Code:07663-6408
Practice Address - Country:US
Practice Address - Phone:973-685-7121
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-28
Last Update Date:2008-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB07566200174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty