MEDICARE: VEIN HEALTH INSTITUTE PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207LP2900X	Pain Medicine (Anesthesiology) Physician

General Provider Information

NPI Number	:	1083382691
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VEIN HEALTH INSTITUTE PC

Provider Business Mailing Address
First Line	:	387 VANCE AVE
Second Line	:
City	:	FRANKLIN LAKES
State	:	NJ
Zip	:	07417-3016
Country	:	US
Telephone Number	:	201-982-4706
Fax Number	:

Provider Business Practice Location Address
First Line	:	387 VANCE AVE
Second Line	:
City	:	FRANKLIN LAKES
State	:	NJ
Zip	:	07417-3016
Country	:	US
Telephone Number	:	201-982-4706
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	ROMAN KOSIBOROD
Credential	:	DO
Telephone Number	:	201-982-4706

Provider Enumeration Date	:	08/31/2021
Last Update Date	:	08/31/2021

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Directions to “VEIN HEALTH INSTITUTE PC ” Practice Location

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