Provider Demographics
NPI:1003989237
Name:MENASHE, RICHARD B (DO)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:B
Last Name:MENASHE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 SO MAIN ST
Mailing Address - Street 2:
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08837
Mailing Address - Country:US
Mailing Address - Phone:732-906-8866
Mailing Address - Fax:732-906-0124
Practice Address - Street 1:15 SO MAIN ST
Practice Address - Street 2:
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08837
Practice Address - Country:US
Practice Address - Phone:732-906-8866
Practice Address - Fax:732-906-0124
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-16
Last Update Date:2016-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB04647400207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
222987240OtherBCBS OF NJ
NJ047830Medicaid
NJ047830Medicaid
NJ464013Medicare ID - Type Unspecified