Provider Demographics
NPI:1801449392
Name:NEUROLOGY AND COGNITIVE NEUROSCIENCE INSTITUTE, INC.
Entity type:Organization
Organization Name:NEUROLOGY AND COGNITIVE NEUROSCIENCE INSTITUTE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:FARZIN
Authorized Official - Middle Name:BENJAMIN
Authorized Official - Last Name:PEDOUIM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-562-5589
Mailing Address - Street 1:2080 CENTURY PARK E STE 1403
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90067-2017
Mailing Address - Country:US
Mailing Address - Phone:844-638-7637
Mailing Address - Fax:310-526-8770
Practice Address - Street 1:2080 CENTURY PARK E STE 1403
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90067-2017
Practice Address - Country:US
Practice Address - Phone:949-239-4410
Practice Address - Fax:310-526-8770
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-23
Last Update Date:2022-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty