Myrtle Health VA LLC

Primary specialty

Physical Medicine & Rehabilitation PhysicianTaxonomy code 208100000X

Legal business name

MYRTLE HEALTH VA 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

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

Authorized official

Name

Edward Shumulinskiy

Title

Owner

Phone

(732) 267-1643

Specialties & licenses 1

Addresses

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": "1811823008",
    "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 VA 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": "OWNER",
        "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": []
}

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• Physical Medicine & Rehabilitation Physician in Lakewood, NJ
• Providers in Lakewood, NJ by specialty
• Physical Medicine & Rehabilitation Physician in New Jersey

• 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.

Verify at the official NPI Registry.