Active NPI
Myrtle Health Ky LLC
- Physical Medicine & Rehabilitation Physician
- Lakewood, NJ
National Provider Identifier
1477489664
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Medicine & Rehabilitation Physician
- Legal business name
- MYRTLE HEALTH KY LLC
- Practice address
- 1382 Lanes Mill Rd Ste 104
Lakewood, NJ 08701-3893 - Phone
- (212) 734-6621
- NPI assigned
- Jun 23, 2026
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Edward Shumulinskiy
- Title
- MD
- Phone
- (732) 267-1643
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Medicine & Rehabilitation Physician | 208100000X | Primary |
Addresses
Primary practice location
1382 Lanes Mill Rd Ste 104
Lakewood, NJ 08701-3893
Mailing address
1382 Lanes Mill Rd Ste 104
Lakewood, NJ 08701-3893
National Provider Directory
National Provider DirectoryLocations
1382 Lanes Mill Rd
Ste 104
Lakewood, NJ 08701
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1782172800000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1784678400000",
"number": "1477489664",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1382 LANES MILL RD STE 104",
"city": "LAKEWOOD",
"state": "NJ",
"postal_code": "087013893"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1382 LANES MILL RD STE 104",
"city": "LAKEWOOD",
"state": "NJ",
"postal_code": "087013893",
"telephone_number": "212-734-6621"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "MYRTLE HEALTH KY LLC",
"organizational_subpart": "NO",
"enumeration_date": "2026-06-23",
"last_updated": "2026-07-22",
"certification_date": "2026-07-22",
"status": "A",
"authorized_official_last_name": "SHUMULINSKIY",
"authorized_official_first_name": "EDWARD",
"authorized_official_title_or_position": "MD",
"authorized_official_telephone_number": "732-267-1643"
},
"taxonomies": [
{
"code": "208100000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Physical Medicine & Rehabilitation",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}
Other providers in Lakewood, NJ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 22, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.