Healthcare Provider Details

I. General information

NPI: 1235530775
Provider Name (Legal Business Name): COGNITIVE CONSULTANTS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/15/2014
Last Update Date: 01/11/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1430 CLOVE RD
STATEN ISLAND NY
10301-4300
US

IV. Provider business mailing address

3 ASCOT PL
NORTH BRUNSWICK NJ
08902-1488
US

V. Phone/Fax

Practice location:
  • Phone: 718-667-1215
  • Fax:
Mailing address:
  • Phone: 516-242-6948
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. YUSUF N MODAN
Title or Position: OWNER
Credential: MD
Phone: 516-242-6948