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General NPI Number Information
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NPI Number | 1215662747
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Entity Type | Organization
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Legal Business Name | SHINE MEDICAL OF NEW JERSEY PC
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Dates
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Enumeration Date | 07/19/2022
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Last Update Date | 02/09/2026
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Provider Practice Location Address
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Address Line | 100 MATAWAN RD STE 325
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City | MATAWAN
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State | NJ
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Zip | 07747-3590
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Country | US
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Telephone | 888-380-2028
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 52476
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City | PHOENIX
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State | AZ
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Zip | 85072-2476
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | SVP OF OPERATIONS
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Name | CLARE FRANCES BOALS FRYE
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Credential |
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Telephone | 616-648-1196
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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