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NPI Code Detail

MEDICARE: SHORE BEHAVIORAL HEALTHCARE, INC.

MEDICARE: SHORE BEHAVIORAL HEALTHCARE, INC.
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
1101YP2500XProfessional Counselor37PC00309400NJ
21041C0700XClinical Social Worker44SC05007700NJ
32084P0800XPsychiatry Physician25MA07531400NJ

General Provider Information

NPI Number : 1891025672
Entity Type Code : Organization
Provider Name (Legal Business Name) : SHORE BEHAVIORAL HEALTHCARE, INC.
Provider Business Mailing Address
First Line : 199 NEW RD STE 62
Second Line :
City : LINWOOD
State : NJ
Zip : 08221-2025
Country : US
Telephone Number : 609-226-1261
Fax Number : 888-487-0032
Provider Business Practice Location Address
First Line : 199 NEW RD STE 62
Second Line :
City : LINWOOD
State : NJ
Zip : 08221-2025
Country : US
Telephone Number : 609-226-1261
Fax Number : 888-487-0032
Authorized Official
Title or Position : MEDICAL DIRECTOR
Name : DR. INUA A. MOMODU
Credential : M.D., M.P.H.
Telephone Number : 609-402-5010
Provider Enumeration Date : 12/30/2009
Last Update Date : 05/26/2026

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