=====================================================
General NPI Number Information
=====================================================
NPI Number | 1194297614
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CHILDPSYCH SERVICES, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/21/2018
-----------------------------------------------------
Last Update Date | 02/04/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 865 STATE ROUTE 33 STE 3-164
-----------------------------------------------------
City | FREEHOLD
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07728-8475
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 732-851-6172
-----------------------------------------------------
Fax | 908-200-7429
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 865 STATE ROUTE 33 STE 3-164
-----------------------------------------------------
City | FREEHOLD
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07728-8475
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 732-851-6172
-----------------------------------------------------
Fax | 908-200-7429
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | VICTOR G GROSU
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 732-851-6172
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084P0804X
-----------------------------------------------------
Taxonomy Name | Child & Adolescent Psychiatry Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------