NPIMap

Organization Active NPI

Michigan State University Clinical Center

  • Clinical Neuropsychologist
  • East Lansing, MI
National Provider Identifier
1255629358
Registry record updated Apr 13, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical NeuropsychologistTaxonomy code 103G00000X
License
6301014684 Issued in MI
Legal business name
MICHIGAN STATE UNIVERSITY CLINICAL CENTER
Practice address
804 Service Rd Ste A114
East Lansing, MI 48824-7038
Phone
(517) 355-7648
Fax
(517) 432-1319
NPI assigned
Jul 11, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 13, 2012

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

Authorized official

Name
Cynthia Zaldokas
Title
MGR Provider Enrollment
Phone
(517) 355-3503

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical NeuropsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103G00000X 6301014684 MI Primary
PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103T00000X 6301006498 MI

Addresses

Primary practice location

804 Service Rd Ste A114
East Lansing, MI 48824-7038

Mailing address

804 Service Rd Ste A114
East Lansing, MI 48824-7038
Phone (517) 355-7648

National Provider Directory

National Provider Directory
Tax ID family
Msu X Ray Associates23 organizations share this tax ID, including this one

Other organizations with this tax ID 22

Organizations that report the same tax identification number in the National Provider Directory.

View all 22

Locations

804 Service Rd
Ste A114
East Lansing, MI 48824
Phone (517) 355-7648

NPI Registry JSON

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

{
    "created_epoch": "1310342400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1334275200000",
    "number": "1255629358",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "804 SERVICE RD STE A114",
            "city": "EAST LANSING",
            "state": "MI",
            "postal_code": "488247038",
            "telephone_number": "517-355-7648",
            "fax_number": "517-432-1319"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "804 SERVICE RD STE A114",
            "city": "EAST LANSING",
            "state": "MI",
            "postal_code": "488247038",
            "telephone_number": "517-355-7648",
            "fax_number": "517-432-1319"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MICHIGAN STATE UNIVERSITY CLINICAL CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-07-11",
        "last_updated": "2012-04-13",
        "status": "A",
        "authorized_official_last_name": "ZALDOKAS",
        "authorized_official_first_name": "CYNTHIA",
        "authorized_official_title_or_position": "MGR PROVIDER ENROLLMENT",
        "authorized_official_telephone_number": "517-355-3503"
    },
    "taxonomies": [
        {
            "code": "103G00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Clinical Neuropsychologist",
            "state": "MI",
            "license": "6301014684",
            "primary": true
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist",
            "state": "MI",
            "license": "6301006498",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in East Lansing, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 13, 2012; 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.