Provider Demographics
NPI:1942447792
Name:COMPREHENSIVE PAIN MEDICINE AND ANESTHESIA GROUP, PC
Entity Type:Organization
Organization Name:COMPREHENSIVE PAIN MEDICINE AND ANESTHESIA GROUP, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER-PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:ROMAN
Authorized Official - Middle Name:
Authorized Official - Last Name:KOSIBOROD
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:201-790-5541
Mailing Address - Street 1:480 MARKET STREET
Mailing Address - Street 2:SUITE 3
Mailing Address - City:SADDLE BROOK
Mailing Address - State:NJ
Mailing Address - Zip Code:07663
Mailing Address - Country:US
Mailing Address - Phone:201-790-5541
Mailing Address - Fax:877-293-7436
Practice Address - Street 1:480 MARKET STREET
Practice Address - Street 2:SUITE 3
Practice Address - City:SADDLE BROOK
Practice Address - State:NJ
Practice Address - Zip Code:07663
Practice Address - Country:US
Practice Address - Phone:973-685-7121
Practice Address - Fax:877-293-7436
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-15
Last Update Date:2023-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB07566200174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty