Healthcare Provider Details

I. General information

NPI: 1033076492
Provider Name (Legal Business Name): GENPSYCH WAYNE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

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

III. Provider practice location address

1501 HAMBURG TPKE STE 201
WAYNE NJ
07470-4032
US

IV. Provider business mailing address

380 FOOTHILL RD
BRIDGEWATER NJ
08807-2255
US

V. Phone/Fax

Practice location:
  • Phone: 855-436-7792
  • Fax:
Mailing address:
  • Phone:
  • 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: HENRY ODUNLAMI
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 908-800-9696