Individual provider Active NPI

Elena Kazakina, PH.D.

  • Clinical Psychologist
  • East Brunswick, NJ
National Provider Identifier
1679624001
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
35SI00411100 Issued in NJ
Practice address
593 Cranbury Rd
East Brunswick, NJ 08816-4029
Phone
(732) 238-9600
NPI assigned
Jan 13, 2007
Last updated
Jul 8, 2007By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
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

IdentifierTypeStateIssuer
02373646MedicaidNY

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
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
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

LicenseStateTypeSpecialty
01538NYMDClinical 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

Verify at the official NPI Registry.