Modern Brain, LLC

Primary specialty

Clinical NeuropsychologistTaxonomy code 103G00000X

License

017975 Issued in NY

Legal business name

MODERN BRAIN, LLC

Practice address

363 7TH Ave
11TH Floor, Suite 5
New York, NY 10001-3904

Phone

(646) 706-2372

NPI assigned

Jan 18, 2017

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Stella Karantzoulis, PH.D.

Title

President

Phone

(646) 706-2372

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1484697600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1484697600000",
    "number": "1477099141",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "245 E 54TH ST",
            "address_2": "8B",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100224707",
            "telephone_number": "646-706-2372"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "363 7TH AVE",
            "address_2": "11TH FLOOR, SUITE 5",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100013904",
            "telephone_number": "646-706-2372"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MODERN BRAIN, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-01-18",
        "last_updated": "2017-01-18",
        "status": "A",
        "authorized_official_last_name": "KARANTZOULIS",
        "authorized_official_first_name": "STELLA",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "646-706-2372",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PH.D."
    },
    "taxonomies": [
        {
            "code": "103G00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Clinical Neuropsychologist",
            "state": "NY",
            "license": "017975",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Clinical Neuropsychologist in New York, NY
• Providers in New York, NY by specialty
• Clinical Neuropsychologist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 18, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.