Provider Demographics
NPI:1508166026
Name:MENON, REKHA (MD)
Entity Type:Individual
Prefix:DR
First Name:REKHA
Middle Name:
Last Name:MENON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:187 CONKLIN AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11236-3727
Mailing Address - Country:US
Mailing Address - Phone:718-408-4949
Mailing Address - Fax:718-257-0505
Practice Address - Street 1:187 CONKLIN AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11236-3727
Practice Address - Country:US
Practice Address - Phone:718-408-4949
Practice Address - Fax:718-257-0505
Is Sole Proprietor?:No
Enumeration Date:2010-11-01
Last Update Date:2013-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY259010-1207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY033328838Medicaid
NYA400046094Medicare PIN