Organization Active NPI

Shore Solutions Therapy Group

  • Professional Counselor
  • Brick, NJ
National Provider Identifier
1457988966
Registry record updated Mar 25, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Professional CounselorTaxonomy code 101YP2500X
Legal business name
SHORE SOLUTIONS THERAPY GROUP
Practice address
212 Jack Martin Blvd Ste D2
Brick, NJ 08724-7771
Phone
(201) 688-0823
Fax
(845) 544-2201
NPI assigned
Mar 25, 2020
Last updated
Mar 25, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 25, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Kenneth McGraw
Title
Administrator
Phone
(201) 688-0823

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Professional Counselor 101YP2500X Primary

Addresses

Primary practice location

212 Jack Martin Blvd Ste D2
Brick, NJ 08724-7771

Mailing address

26 N Main St Ste 4
Florida, NY 10921-1350
Phone (201) 688-0823

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20240521002898 NJ Part B Supplier - Clinic/Group Practice 1456703875 Receives reassigned benefits from 1 practitioner
Practice locations: Brick, NJ

National Provider Directory

National Provider Directory

Locations

212 Jack Martin Blvd
Ste D
Brick, NJ 08724
Phone (848) 232-3507

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1585094400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1585094400000",
    "number": "1457988966",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "26 N MAIN ST STE 4",
            "city": "FLORIDA",
            "state": "NY",
            "postal_code": "109211350",
            "telephone_number": "201-688-0823"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "212 JACK MARTIN BLVD STE D2",
            "city": "BRICK",
            "state": "NJ",
            "postal_code": "087247771",
            "telephone_number": "201-688-0823",
            "fax_number": "845-544-2201"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHORE SOLUTIONS THERAPY GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-03-25",
        "last_updated": "2020-03-25",
        "certification_date": "2020-03-25",
        "status": "A",
        "authorized_official_last_name": "MCGRAW",
        "authorized_official_first_name": "KENNETH",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "201-688-0823"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Brick, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 25, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.