Healthcare Provider Details

I. General information

NPI: 1740750678
Provider Name (Legal Business Name): GENPSYCH PC BRIDGEWATER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/04/2018
Last Update Date: 09/20/2023
Certification Date: 09/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

380 FOOTHILL RD
BRIDGEWATER NJ
08807-2255
US

IV. Provider business mailing address

1065 US HIGHWAY 22 STE 3
BRIDGEWATER NJ
08807-2949
US

V. Phone/Fax

Practice location:
  • Phone: 908-231-0511
  • Fax: 908-231-1115
Mailing address:
  • Phone: 908-526-8370
  • Fax:

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: MARIANNE MAGSAYSAY
Title or Position: DIRECTOR OF OPERATIONS
Credential:
Phone: 908-526-8370