Healthcare Provider Details

I. General information

NPI: 1851098008
Provider Name (Legal Business Name): CENTER FOR NEUROCOGNITIVE THERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/08/2023
Last Update Date: 02/08/2023
Certification Date: 02/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

381 PARK STREET SUITE 2B
HACKENSACK NJ
07601-4350
US

IV. Provider business mailing address

PO BOX 1447
ENGLEWOOD CLIFFS NJ
07632-1447
US

V. Phone/Fax

Practice location:
  • Phone: 201-968-5097
  • Fax: 201-464-2278
Mailing address:
  • Phone: 201-967-8425
  • Fax: 201-967-8443

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084N0600X
TaxonomyClinical Neurophysiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2084S0012X
TaxonomySleep Medicine (Psychiatry & Neurology) Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2084E0001X
TaxonomyEpilepsy Physician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: GEORGES GHACIBEH
Title or Position: M.D.
Credential: M.D.
Phone: 201-968-5097