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General NPI Number Information
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NPI Number | 1235530775
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Entity Type | Organization
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Legal Business Name | COGNITIVE CONSULTANTS, LLC
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Dates
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Enumeration Date | 09/15/2014
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Last Update Date | 01/11/2015
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Provider Practice Location Address
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Address Line | 1430 CLOVE RD
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City | STATEN ISLAND
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State | NY
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Zip | 10301-4300
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Country | US
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Telephone | 718-667-1215
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Fax |
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Provider Business Mailing Address
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Address Line | 3 ASCOT PL
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City | NORTH BRUNSWICK
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State | NJ
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Zip | 08902-1488
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Country | US
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Telephone | 516-242-6948
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. YUSUF N MODAN
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Credential | MD
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Telephone | 516-242-6948
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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