Provider Demographics
NPI:1194211789
Name:CENTER FOR COGNITION AND COMMUNICATION
Entity Type:Organization
Organization Name:CENTER FOR COGNITION AND COMMUNICATION
Other - Org Name:CCC
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:W
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-535-8932
Mailing Address - Street 1:418 E 71ST ST FL 4
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-4892
Mailing Address - Country:US
Mailing Address - Phone:212-535-8932
Mailing Address - Fax:
Practice Address - Street 1:418 E 71ST ST FL 4
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-4892
Practice Address - Country:US
Practice Address - Phone:212-535-8932
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-06
Last Update Date:2022-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084B0040XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyBehavioral Neurology & NeuropsychiatryGroup - Single Specialty
No2084P0301XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyBrain Injury MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY109328900Medicaid
NY107577-1WOtherWORKERS' COMPENSATION CERTIFICATION OF AUTHORIZATION