MEDICARE: YMCA OF THE JERSEY SHORE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency	1000053704	NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1164941043
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	YMCA OF THE JERSEY SHORE

Provider Business Mailing Address
First Line	:	166 MAIN ST
Second Line	:
City	:	MATAWAN
State	:	NJ
Zip	:	07747-3104
Country	:	US
Telephone Number	:	732-290-9040
Fax Number	:	732-566-0433

Provider Business Practice Location Address
First Line	:	3911 HERBERTSVILLE RD
Second Line	:
City	:	WALL TOWNSHIP
State	:	NJ
Zip	:	08724-0904
Country	:	US
Telephone Number	:	732-290-9040
Fax Number	:	732-566-0433

Authorized Official
Title or Position	:	VICE PRESIDENT
Name	:	CORY CUOMO
Credential	:	LCSW
Telephone Number	:	732-290-9040

Provider Enumeration Date	:	09/12/2017
Last Update Date	:	07/17/2025

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Directions to “YMCA OF THE JERSEY SHORE ” Practice Location

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