Active NPI
Ryan Mendoza, PSY.D.
- Clinical Psychologist
- New Brunswick, NJ
National Provider Identifier
1104951599
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 35SI00463500
- Practice address
- 254 Easton Ave
New Brunswick, NJ 08901-1766 - Phone
- (732) 339-7045
- NPI assigned
- Feb 23, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | PSY203580 | CA | |
| Clinical Psychologist | 103TC0700X | 35SI00463500 | NJ | Primary |
Addresses
Primary practice location
254 Easton Ave
New Brunswick, NJ 08901-1766
Mailing address
254 Easton Ave
New Brunswick, NJ 08901-1766
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PSY203580 | CA | MD | Clinical Psychologist |
| 35SI00463500 | NJ | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1172188800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1416960000000",
"number": "1104951599",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "254 EASTON AVE",
"city": "NEW BRUNSWICK",
"state": "NJ",
"postal_code": "089011766"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "254 EASTON AVE",
"city": "NEW BRUNSWICK",
"state": "NJ",
"postal_code": "089011766",
"telephone_number": "732-339-7045"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MENDOZA",
"first_name": "RYAN",
"name_prefix": "Dr.",
"credential": "PSY.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-02-23",
"last_updated": "2014-11-26",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "CA",
"license": "PSY203580",
"primary": false
},
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "NJ",
"license": "35SI00463500",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in New Brunswick, NJ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 26, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.