Healthcare Provider Details

I. General information

NPI: 1750129490
Provider Name (Legal Business Name): MODERN PSYCHIATRY NJ PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2024
Last Update Date: 07/17/2024
Certification Date: 07/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 HOSPITAL DR STE 4
TOMS RIVER NJ
08755-6434
US

IV. Provider business mailing address

20 HOSPITAL DR STE 4
TOMS RIVER NJ
08755-6434
US

V. Phone/Fax

Practice location:
  • Phone: 732-831-6094
  • Fax:
Mailing address:
  • Phone: 732-831-6094
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License Number
License Number State

VIII. Authorized Official

Name: FELIX ARON GELLER
Title or Position: CEO
Credential:
Phone: 732-571-0025