Basic Information
| Provider Information | |||||||||
| NPI: | 1013991470 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ANISKIEWICZ | ||||||||
| FirstName: | ALBERT | ||||||||
| MiddleName: | STANLEY | ||||||||
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| Credential: | PH.D., ABPP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 804 SERVICE RD STE A109B | ||||||||
| Address2: | |||||||||
| City: | EAST LANSING | ||||||||
| State: | MI | ||||||||
| PostalCode: | 488247015 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 1735349115 | ||||||||
| FaxNumber: | 5174323928 | ||||||||
| Practice Location | |||||||||
| Address1: | 909 FEE RD ROOM B119 | ||||||||
| Address2: | MICHIGAN STATE UNIVERSITY DEPARTMENT OF PSYCHIATRY | ||||||||
| City: | EAST LANSING | ||||||||
| State: | MI | ||||||||
| PostalCode: | 488241315 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5173533070 | ||||||||
| FaxNumber: | 5174323603 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/30/2005 | ||||||||
| LastUpdateDate: | 06/07/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/07/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103G00000X | 6301001543 | MI | N | Behavioral Health & Social Service Providers | Clinical Neuropsychologist | 103TC0700X | 6301001543 | MI | Y | Behavioral Health & Social Service Providers | Psychologist | Clinical |
No ID Information.