Organization
COGNITIVE CONSULTANTS, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. YUSUF N MODAN MD (OWNER)
(516) 242-6948
Entity
Organization
Contact information
Practice address
1430 CLOVE RD, STATEN ISLAND, NY 10301-4300
(718) 667-1215
Mailing address
3 ASCOT PL, NORTH BRUNSWICK, NJ 08902-1488
(516) 242-6948
Taxonomy
Speciality
Code
Description
License number
State
261QM0850X
Adult Mental Health Clinic/Center
Primary
—
—
261QM0855X
Adolescent and Children Mental Health Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1235530775
NPI
NY
Enumeration date
09/15/2014
Last updated
01/11/2015
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