Healthcare Provider Details

I. General information

NPI: 1710100433
Provider Name (Legal Business Name): CENTER FOR NEUROFEEDBACK AND INTEGRATIVE HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/11/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 FOREST AVE
PARAMUS NJ
07652-5241
US

IV. Provider business mailing address

6 FOREST AVE
PARAMUS NJ
07652-5241
US

V. Phone/Fax

Practice location:
  • Phone: 201-655-7848
  • Fax: 201-655-7851
Mailing address:
  • Phone: 201-655-7848
  • Fax: 201-655-7851

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code102L00000X
TaxonomyPsychoanalyst
License NumberMA 056615
License Number StateNJ

VIII. Authorized Official

Name: DR. FREDERICK ELLIOT KAHN
Title or Position: VICE PRESIDENT
Credential: M.D.
Phone: 201-587-0414