Healthcare Provider Details

I. General information

NPI: 1699005405
Provider Name (Legal Business Name): MR. RUSHAB MENON
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/30/2009
Last Update Date: 05/22/2026
Certification Date: 05/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 LEXINGTON AVE
EAST BRUNSWICK NJ
08816-5037
US

IV. Provider business mailing address

3 LEXINGTON AVE
EAST BRUNSWICK NJ
08816-5037
US

V. Phone/Fax

Practice location:
  • Phone: 732-432-0999
  • Fax:
Mailing address:
  • Phone: 732-432-0999
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number28RI04082000
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number053861
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: