=====================================================
General NPI Number Information
=====================================================
NPI Number | 1902598311
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | COGNOSIS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/24/2023
-----------------------------------------------------
Last Update Date | 01/30/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 541 CEDAR HILL AVE STE 2
-----------------------------------------------------
City | WYCKOFF
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07481-2133
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 551-444-0924
-----------------------------------------------------
Fax | 866-315-8961
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 541 CEDAR HILL AVE STE 2
-----------------------------------------------------
City | WYCKOFF
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07481-2133
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 551-444-0924
-----------------------------------------------------
Fax | 866-315-8961
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGING MEMBER
-----------------------------------------------------
Name | DR. DANIEL DEFEO
-----------------------------------------------------
Credential | DO
-----------------------------------------------------
Telephone | 551-500-5708
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084P0800X
-----------------------------------------------------
Taxonomy Name | Psychiatry Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------