Healthcare Provider Details

I. General information

NPI: 1629797451
Provider Name (Legal Business Name): JERSEY SHORE HEALING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2022
Last Update Date: 08/24/2022
Certification Date: 08/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5170 ROUTE 9 S
HOWELL NJ
07731-3359
US

IV. Provider business mailing address

5170 ROUTE 9 S
HOWELL NJ
07731-3359
US

V. Phone/Fax

Practice location:
  • Phone: 732-278-6907
  • Fax:
Mailing address:
  • Phone: 732-278-6907
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number State

VIII. Authorized Official

Name: AVROHOM SCHWINDER
Title or Position: CLINICAL DIRECTOR
Credential: CRNA
Phone: 248-318-1275