Provider Demographics
NPI:1922422237
Name:ALLIANCE SPINE ASSOCIATES LLC
Entity Type:Organization
Organization Name:ALLIANCE SPINE ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPECIALIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ROMAN
Authorized Official - Middle Name:
Authorized Official - Last Name:KOSIBOROD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-685-7121
Mailing Address - Street 1:39-40 BROADWAY STE 1
Mailing Address - Street 2:
Mailing Address - City:FAIR LAWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07410-5413
Mailing Address - Country:US
Mailing Address - Phone:201-509-8998
Mailing Address - Fax:973-246-7120
Practice Address - Street 1:39-40 BROADWAY STE 1
Practice Address - Street 2:
Practice Address - City:FAIR LAWN
Practice Address - State:NJ
Practice Address - Zip Code:07410-5413
Practice Address - Country:US
Practice Address - Phone:201-509-8998
Practice Address - Fax:973-246-7120
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-06
Last Update Date:2019-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB07566200207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty