Healthcare Provider Details

I. General information

NPI: 1013374511
Provider Name (Legal Business Name): COGNITIVE NEUROLOGY CONSULTANTS PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/28/2016
Last Update Date: 08/21/2025
Certification Date: 08/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18 E 41ST ST FL 14
NEW YORK NY
10017-6244
US

IV. Provider business mailing address

747 W 231ST ST
BRONX NY
10463-1003
US

V. Phone/Fax

Practice location:
  • Phone: 305-395-4313
  • Fax: 954-840-8254
Mailing address:
  • Phone: 786-620-3204
  • Fax: 954-840-8254

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084B0040X
TaxonomyBehavioral Neurology & Neuropsychiatry Physician
License NumberME122509
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ALON SEIFAN
Title or Position: PRESIDENT
Credential: MD
Phone: 786-620-3204