NPIMap

Organization Active NPI

Msu Center for Audiology and Speech Language Pathology

  • Audiologist
  • Bloomfield, NJ
National Provider Identifier
1508038365
Registry record updated Jun 11, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
AudiologistTaxonomy code 231H00000X
Legal business name
MSU CENTER FOR AUDIOLOGY AND SPEECH LANGUAGE PATHOLOGY
Practice address
Msu Center for Audiology and Speech Language Pathology
1515 Broad Street
Bloomfield, NJ 07003
Phone
(973) 655-3934
Fax
(973) 655-7752
NPI assigned
Apr 1, 2008
Last updated
Jun 11, 2020By the provider in NPPES
Organization subpart
Yes
Parent organization
MONTCLAIR STATE UNIVERSITYAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 11, 2020

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

Authorized official

Name
Ms. Donna McMonagle
Title
Vice President for Finance and Trea
Phone
(973) 655-5105

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Audiologist 231H00000X NU Primary
Speech-Language Pathologist 235Z00000X NU

Addresses

Primary practice location

Msu Center for Audiology and Speech Language Pathology
1515 Broad Street
Bloomfield, NJ 07003

Mailing address

Msu Center for Audiology and Speech Language Pathology
1515 Broad Street
Bloomfield, NJ 07003
Phone (973) 655-3934

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20110614000186 NJ Part B Supplier - Clinic/Group Practice 0446437784 Receives reassigned benefits from 6 practitioners
2 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Bloomfield, NJ; Montclair, NJ

Other NPIs on the same Medicare enrollment 2

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Montclair State University4 organizations share this tax ID, including this one
Part of
Montclair State University

Other organizations with this tax ID 3

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

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1207008000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1591833600000",
    "number": "1508038365",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "MSU CENTER FOR AUDIOLOGY AND SPEECH LANGUAGE PATHOLOGY",
            "address_2": "1515 BROAD STREET",
            "city": "BLOOMFIELD",
            "state": "NJ",
            "postal_code": "07003",
            "telephone_number": "973-655-3934",
            "fax_number": "973-655-7752"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "MSU CENTER FOR AUDIOLOGY AND SPEECH LANGUAGE PATHOLOGY",
            "address_2": "1515 BROAD STREET",
            "city": "BLOOMFIELD",
            "state": "NJ",
            "postal_code": "07003",
            "telephone_number": "973-655-3934",
            "fax_number": "973-655-7752"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MSU CENTER FOR AUDIOLOGY AND SPEECH LANGUAGE PATHOLOGY",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MONTCLAIR STATE UNIVERSITY",
        "enumeration_date": "2008-04-01",
        "last_updated": "2020-06-11",
        "certification_date": "2020-06-11",
        "status": "A",
        "authorized_official_last_name": "MCMONAGLE",
        "authorized_official_first_name": "DONNA",
        "authorized_official_title_or_position": "VICE PRESIDENT FOR FINANCE AND TREA",
        "authorized_official_telephone_number": "973-655-5105",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "231H00000X",
            "taxonomy_group": "",
            "desc": "Audiologist",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bloomfield, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 11, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.