Healthcare Provider Details

I. General information

NPI: 1477035996
Provider Name (Legal Business Name): GENPSYCH BRICK
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2018
Last Update Date: 01/07/2026
Certification Date: 01/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

940 CEDAR BRIDGE AVE FL 1
BRICK NJ
08723
US

IV. Provider business mailing address

981 US HIGHWAY 22
BRIDGEWATER NJ
08807-2946
US

V. Phone/Fax

Practice location:
  • Phone: 732-475-6152
  • Fax: 732-475-6172
Mailing address:
  • Phone: 908-526-8370
  • Fax: 908-801-6850

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: HENRY ODUNLAMI
Title or Position: CEO
Credential:
Phone: 908-526-8370