Subject Numbers Regarding Health Provider Authorizations

Authorization No. 221118-3W

April 24, 2024

Please be advised that Dr. Roman Kosiborod (hereinafter, "the provider") has resigned their authorization to treat injured workers in the New York State workers' compensation system effective April 22, 2024. The provider's last known practice addresses are:

Comprehensive Pain Medicine
480 Market Street, Suite 301
Saddle Brook, New Jersey 07663

14 North Main Street
Spring Valley, New York 10977

The provider is prohibited from rendering treatment and care to injured workers, and from conducting reviews of records regarding variance requests pursuant to 12 New York Codes, Rules and Regulations § 324.3(b)(2)(ii)(a). Reports submitted by the provider for services rendered prior to April 22, 2024, are valid but are invalid for any services rendered on or after that date. Requests to cross-examine the provider for services rendered prior to April 22, 2024, should not be denied due to their resignation.

Any questions regarding the authorized lists should be referred to the Medical Director's Office at 1 (800) 781-2362.