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General NPI Number Information
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NPI Number | 1922546167
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Entity Type | Organization
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Legal Business Name | YMCA OF THE JERSEY SHORE
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Dates
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Enumeration Date | 02/08/2017
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Last Update Date | 07/16/2025
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Provider Practice Location Address
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Address Line | 469 MATAWAN AVE
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City | CLIFFWOOD
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State | NJ
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Zip | 07721-1203
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Country | US
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Telephone | 732-290-9040
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Fax | 732-566-0433
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Provider Business Mailing Address
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Address Line | 166 MAIN ST
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City | MATAWAN
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State | NJ
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Zip | 07747-3104
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Country | US
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Telephone | 732-290-9040
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Fax | 732-566-0433
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | CORY CUOMO
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Credential | LCSW
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Telephone | 732-290-9040
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 10000521304
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License Number State | NJ
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