Healthcare Provider Details

I. General information

NPI: 1649046376
Provider Name (Legal Business Name): GENPSYCH MARLBORO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

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

III. Provider practice location address

55 WILLOW LN
ENGLISHTOWN NJ
07726-8434
US

IV. Provider business mailing address

380 FOOTHILL RD STE 1
BRIDGEWATER NJ
08807-2255
US

V. Phone/Fax

Practice location:
  • Phone: 848-309-2400
  • Fax:
Mailing address:
  • Phone: 908-526-8370
  • Fax: 908-526-8722

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 MALDONADO
Title or Position: DIRECTOR OF OPERATIONS AND HR
Credential:
Phone: 908-526-8370