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General NPI Number Information
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NPI Number | 1457843633
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Entity Type | Individual
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Provider Name | AJAY MENON DO
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Gender | Male
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Dates
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Enumeration Date | 06/04/2018
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Last Update Date | 08/13/2025
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Provider Practice Location Address
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Address Line | 425 JACK MARTIN BLVD
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City | BRICK
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State | NJ
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Zip | 08724-7732
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Country | US
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Telephone | 732-202-1500
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Fax | 732-202-1058
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Provider Business Mailing Address
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Address Line | 425 JACK MARTIN BLVD
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City | BRICK
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State | NJ
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Zip | 08724-7732
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 25MB12592900
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 2086S0129X
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Taxonomy Name | Vascular Surgery Physician
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License Number | 25MB12592900
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License Number State | NJ
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