Active NPI
Elena Kazakina, PH.D.
- Clinical Psychologist
- East Brunswick, NJ
National Provider Identifier
1679624001
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 35SI00411100
- Practice address
- 593 Cranbury Rd
East Brunswick, NJ 08816-4029 - Phone
- (732) 238-9600
- NPI assigned
- Jan 13, 2007
- Last updated
- Jul 8, 2007
- Sex
- Female
- Sole proprietor
- Yes
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 | 35SI00411100 | NJ | Primary |
| Clinical Psychologist | 103TC0700X | 01538 | NY |
Addresses
Primary practice location
593 Cranbury Rd
East Brunswick, NJ 08816-4029
Mailing address
277 Bromley PL
East Brunswick, NJ 08816-5126
Phone (732) 254-0456
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 02373646 | Medicaid | NY |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NJ
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20040707000948 | NJ | Practitioner - Clinical Psychologist | 6901883974 | Practice locations: E Brunswick, NJ |
Care Compare profile
Medicare Care Compare- Specialty
- Clinical Psychologist
- Education
- Other, 1999
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
Practice addresses (Care Compare)
593 Cranbury Rd
E Brunswick, NJ 08816-4093
Phone (732) 238-9600
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 01538 | NY | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1168646400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1679624001",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "277 BROMLEY PL",
"city": "EAST BRUNSWICK",
"state": "NJ",
"postal_code": "088165126",
"telephone_number": "732-254-0456"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "593 CRANBURY RD",
"city": "EAST BRUNSWICK",
"state": "NJ",
"postal_code": "088164029",
"telephone_number": "732-238-9600"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KAZAKINA",
"first_name": "ELENA",
"name_prefix": "Dr.",
"credential": "PH.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-01-13",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "NJ",
"license": "35SI00411100",
"primary": true
},
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "NY",
"license": "01538",
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "02373646",
"state": "NY"
}
],
"endpoints": [],
"other_names": []
}
Other providers in East Brunswick, NJ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.