Provider Demographics
NPI:1215662747
Name:SHINE MEDICAL OF NEW JERSEY PC
Entity type:Organization
Organization Name:SHINE MEDICAL OF NEW JERSEY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SVP OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:CLARE
Authorized Official - Middle Name:FRANCES BOALS
Authorized Official - Last Name:FRYE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:616-648-1196
Mailing Address - Street 1:PO BOX 360721
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15251-6721
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:100 MATAWAN RD STE 325
Practice Address - Street 2:
Practice Address - City:MATAWAN
Practice Address - State:NJ
Practice Address - Zip Code:07747-3590
Practice Address - Country:US
Practice Address - Phone:888-380-2028
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-19
Last Update Date:2024-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty