Healthcare Provider Details

I. General information

NPI: 1891757407
Provider Name (Legal Business Name): RAKESH MENON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2006
Last Update Date: 01/29/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

187 CONKLIN AVE
BROOKLYN NY
11236-3727
US

IV. Provider business mailing address

187 CONKLIN AVE
BROOKLYN NY
11236-3727
US

V. Phone/Fax

Practice location:
  • Phone: 718-408-4949
  • Fax: 718-257-0505
Mailing address:
  • Phone: 718-408-4949
  • Fax: 718-257-0505

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number212799
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: