Provider Demographics
NPI:1538050703
Name:HURLEY, SHANE
Entity type:Individual
Prefix:
First Name:SHANE
Middle Name:
Last Name:HURLEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:231 HACKENSACK PLANK RD APT 104
Mailing Address - Street 2:
Mailing Address - City:WEEHAWKEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07086-5923
Mailing Address - Country:US
Mailing Address - Phone:201-783-2807
Mailing Address - Fax:
Practice Address - Street 1:231 HACKENSACK PLANK RD APT 104
Practice Address - Street 2:
Practice Address - City:WEEHAWKEN
Practice Address - State:NJ
Practice Address - Zip Code:07086-5923
Practice Address - Country:US
Practice Address - Phone:201-783-2807
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-14
Last Update Date:2025-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJRBT-25-429777106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician