Provider Demographics
NPI:1891020947
Name:NEUROREHABILITATION AND NEUROPSYCHOLICAL SERVICES P.C.
Entity Type:Organization
Organization Name:NEUROREHABILITATION AND NEUROPSYCHOLICAL SERVICES P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:COBEN
Authorized Official - Suffix:
Authorized Official - Credentials:PH D
Authorized Official - Phone:516-799-8599
Mailing Address - Street 1:1035 PARK BLVD
Mailing Address - Street 2:SUITE 2B
Mailing Address - City:MASSAPEQUA PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11762-2743
Mailing Address - Country:US
Mailing Address - Phone:516-799-8599
Mailing Address - Fax:
Practice Address - Street 1:1035 PARK BLVD
Practice Address - Street 2:SUITE 2B
Practice Address - City:MASSAPEQUA PARK
Practice Address - State:NY
Practice Address - Zip Code:11762-2743
Practice Address - Country:US
Practice Address - Phone:516-799-8599
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-07
Last Update Date:2009-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012160-1103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01733191Medicaid
NYV1559Medicare PIN