MEDICARE: NIKHIL MENON M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	290754	NY

General Provider Information

NPI Number	:	1285096651
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NIKHIL MENON M.D.

Provider Business Mailing Address
First Line	:	2825 JACKSON AVE FL 2
Second Line	:
City	:	LONG ISLAND CITY
State	:	NY
Zip	:	11101-2920
Country	:	US
Telephone Number	:	646-962-4170
Fax Number	:	646-962-0186

Provider Business Practice Location Address
First Line	:	2825 JACKSON AVE FL 2
Second Line	:
City	:	LONG ISLAND CITY
State	:	NY
Zip	:	11101-2920
Country	:	US
Telephone Number	:	646-962-4170
Fax Number	:	646-962-0186

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/24/2016
Last Update Date	:	06/28/2023

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