Provider Demographics
NPI:1336174721
Name:JONATHAN A KOST, MD LLC
Entity Type:Organization
Organization Name:JONATHAN A KOST, MD LLC
Other - Org Name:HARTFORD HOSPITAL PAIN TREATMENT CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:KOST
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:860-696-2843
Mailing Address - Street 1:PO BOX 448
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06034-0448
Mailing Address - Country:US
Mailing Address - Phone:860-585-3311
Mailing Address - Fax:860-585-3145
Practice Address - Street 1:65 MEMORIAL RD
Practice Address - Street 2:
Practice Address - City:WEST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06107-2434
Practice Address - Country:US
Practice Address - Phone:860-696-2843
Practice Address - Fax:860-696-2845
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-12
Last Update Date:2010-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT6156360001Medicare NSC