Healthcare Provider Details

I. General information

NPI: 1922546167
Provider Name (Legal Business Name): YMCA OF THE JERSEY SHORE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/08/2017
Last Update Date: 07/16/2025
Certification Date: 07/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

469 MATAWAN AVE
CLIFFWOOD NJ
07721-1203
US

IV. Provider business mailing address

166 MAIN ST
MATAWAN NJ
07747-3104
US

V. Phone/Fax

Practice location:
  • Phone: 732-290-9040
  • Fax: 732-566-0433
Mailing address:
  • Phone: 732-290-9040
  • Fax: 732-566-0433

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number10000521304
License Number StateNJ

VIII. Authorized Official

Name: CORY CUOMO
Title or Position: VICE PRESIDENT
Credential: LCSW
Phone: 732-290-9040