Healthcare Provider Details

I. General information

NPI: 1558278671
Provider Name (Legal Business Name): COGNITIVE MEDICAL WELLNESS OF NEW YORK PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/25/2026
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 E 60TH ST RM 2403
NEW YORK NY
10022-1788
US

IV. Provider business mailing address

30 E 60TH ST RM 2403
NEW YORK NY
10022-1788
US

V. Phone/Fax

Practice location:
  • Phone: 212-233-2838
  • Fax:
Mailing address:
  • Phone: 516-295-4867
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: EDWARD FRUITMAN
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 917-796-3348