JED GARY MAGEN (NPI# 1619951936) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1619951936 |
| Entity Type | Individual |
| Full Name | JED GARY MAGEN |
| Credential | D.O. |
| Practice Address |
909 Fee Rd Room B119 Michigan State University Department of Psychiatry East Lansing MI 48824-3603 |
| Mailing Address |
965 Fee Rd Room A239 Michigan State University Department of Psychiatry East Lansing MI 48824-2893 |
| Practice Telephone | 5173533070 |
| Practice Fax Number | 5174323603 |
| Mailing Telephone | 5173533070 |
| Mailing Fax Number | 5174323603 |
| Enumeration Date | 2005-11-30 |
| Last Update Date | 2012-03-12 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 2084P0800X |
Psychiatry & Neurology Specialization: Psychiatry |
5101007621 | MI | Allopathic & Osteopathic Physicians |
| Y | 2084P0804X |
Psychiatry & Neurology Specialization: Child & Adolescent Psychiatry |
5101007621 | MI | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MI | 1619951936 | 05 | |
| MI | 2574234 | 05 |
| Street Address |
909 FEE RD ROOM B119 MICHIGAN STATE UNIVERSITY DEPARTMENT OF PSYCHIATRY |
| City | EAST LANSING |
| State | MI |
| Zip Code | 48824-3603 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1255315628 | Deborah Banazak Wagenaar | Psychiatry & Neurology | 909 Fee Rd Room B119, Michigan State University Department of Psychiatry, East Lansing, MI 48824-3603 | 2005-11-30 |
| 1861609992 | Alyse F Ley | Psychiatry & Neurology | 909 Fee Rd Room B119, East Lansing, MI 48824-3603 | 2007-05-17 |
| 1952337545 | Michigan State University Dept of Psychiatry | Psychiatry & Neurology | 909 Fee Rd Room B119, East Lansing, MI 48824-6549 | 2006-06-24 |
| 1083698930 | Christine Larsen Shafer | Psychiatry & Neurology | 909 Fee Rd Room B119, Michigan State University Department of Psychiatry, East Lansing, MI 48824-3603 | 2005-12-05 |
| 1518941574 | Dianne Seaver Singleton | Psychologist | 909 Fee Rd Room B119, Michigan State University Department of Psychiatry, East Lansing, MI 48824-3603 | 2005-12-02 |
| 1962486928 | Christopher Paul Giuliano | Psychologist | 909 Fee Rd Room B119, Michigan State University Department of Psychiatry, East Lansing, MI 48824-3603 | 2005-12-02 |
| 1013991470 | Albert Stanley Aniskiewicz | Clinical Neuropsychologist | 909 Fee Rd Room B119, Michigan State University Department of Psychiatry, East Lansing, MI 48824-1315 | 2005-11-30 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1528680303 | Emilia Elizabeth Mattioli | Psychiatry & Neurology | 965 Fee Road Room A223, East Lansing, MI 48824 | 2020-05-14 |
| 1447871983 | James O'brien | Psychiatry & Neurology | Msu Psychiatry Residency Program, 965 Fee Road, Room A233, East Lansing, MI 48824 | 2020-05-06 |
| 1750916979 | Mulin Xiong | Student in an Organized Health Care Education/Training Program | 965 Wilson Road Suite A110, East Fee Hall, East Lansing, MI 48824 | 2020-03-09 |
| 1821659301 | Tovah Apolonia Aho | Psychiatry & Neurology | Michigan State University Psychiatric Residency, 965 Fee Road, Room A233, East Lansing, MI 48824 | 2019-06-25 |
| 1912564881 | Asmara Theresa Hoo | Psychiatry & Neurology | 965 Fee Road, Room A233, East Lansing, MI 48824 | 2019-05-24 |
| 1790276822 | Traverse Health Clinic and Coalition | Clinic/Center | East Fee Hall 965 Fee Road, Room A222, East Lansing, MI 48824 | 2018-05-24 |
| 1922598515 | Jubin Joseph Cheruvelil | Specialist/Technologist, Other | 446 W. Circle Dr. Room 249 Annex, Justin S. Morrill Hall of Agriculture, East Lansing, MI 48824 | 2018-05-18 |
| 1073003257 | Dawn Arvye Contreras | Health Educator | 446 West Circle Dr., Justin S. Morrill Hall of Agriculture, Room 166, East Lansing, MI 48824 | 2018-05-14 |
| 1710406046 | Kimberly Ann Breukink | Social Worker | 463 East Circle Drive, Michigan State University, Counseling and Psychiatric Services, East Lansing, MI 48824 | 2017-09-19 |
| 1043766314 | Ahmed Jouan | Psychiatry & Neurology | 804 Service Rd A217, East Lansing, MI 48824 | 2016-08-28 |
| Find all providers in zip 48824 | ||||
| Taxonomy Code | 2084P0804X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Psychiatry & Neurology |
| Specialization | Child & Adolescent Psychiatry |
| Child & Adolescent Psychiatry is a subspecialty of psychiatry with additional skills and training in the diagnosis and treatment of developmental, behavioral, emotional, and mental disorders of childhood and adolescence. |
| Notes: Source: The American Board of Psychiatry and Neurology, Inc. www.abpn.com [1/1/2007: new definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1154760312 | Samantha Fugate Kennedy | Psychiatry & Neurology | 909 Fee Rd Ste B119, East Lansing, MI 48824 | 2013-06-21 |
| 1629416169 | Shady S Shebak | Psychiatry & Neurology | 965 Fee Rd, Room A233 East Fee Hall, East Lansing, MI 48824-6410 | 2013-06-06 |
| 1902981103 | Leslie Greene Macauley | Psychiatry & Neurology | 4970 Northwind Dr, East Lansing, MI 48823-5080 | 2006-10-26 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1316376056 | Esmaeil Emami | Psychiatry & Neurology | 2955 Franklin Rd, Bloomfield Hills, MI 48302-0917 | 2013-11-04 |
| 1407199961 | David Donald Krohn | Psychiatry & Neurology | 563 Highland Park Dr, Traverse City, MI 49686-2863 | 2013-04-03 |
| 1164712055 | Tatjana Maric | Psychiatry & Neurology | 420 Baltimore Dr Ne, Grand Rapids, MI 49503-3934 | 2011-04-12 |
| 1972893824 | Katherine Barbara Krive | Psychiatry & Neurology | 801 S Waverly Rd Ste 100, Lansing, MI 48917-4200 | 2011-04-12 |
| 1104128602 | Hope Network Behavioral Health Services | Psychiatry & Neurology | 3361 36th Street, Grand Rapids, MI 49512 | 2010-12-03 |
| 1295056653 | Veronica Yap Tan | Psychiatry & Neurology | 23354 Portage Way, Apt. 2212, Novi, MI 48375 | 2010-06-18 |
| 1548588874 | Katie Alanna Keller | Psychiatry & Neurology | 79 Alexandrine West, Detroit, MI 48201 | 2010-05-11 |
| 1538390133 | Behavioral Health Associates Pllc | Psychiatry & Neurology | 19500 Middlebelt Rd, Suite 350e, Livonia, MI 48152-2196 | 2009-07-30 |
| 1235375775 | Kristine Baker | Psychiatry & Neurology | 721 Cherokee St, Traverse City, MI 49684-1401 | 2009-01-06 |
| 1689820078 | Margaret Mary Casey | Psychiatry & Neurology | 1326 Saint Antoine St, Detroit, MI 48226-2301 | 2008-08-18 |
| Find all providers with the same taxonomy | ||||
| City | EAST LANSING |
| Zip Code | 48824 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.