Provider Demographics
NPI:1619125150
Name:MENON, ADITI SEN (MD)
Entity Type:Individual
Prefix:DR
First Name:ADITI
Middle Name:SEN
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:PO BOX C
Mailing Address - Street 2:
Mailing Address - City:SHORT HILLS
Mailing Address - State:NJ
Mailing Address - Zip Code:07078-0381
Mailing Address - Country:US
Mailing Address - Phone:908-382-5002
Mailing Address - Fax:908-322-1120
Practice Address - Street 1:45 ESSEX ST STE 202
Practice Address - Street 2:
Practice Address - City:MILLBURN
Practice Address - State:NJ
Practice Address - Zip Code:07041-1668
Practice Address - Country:US
Practice Address - Phone:973-382-5002
Practice Address - Fax:973-924-0882
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-08
Last Update Date:2021-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA08493700207XX0005X, 208VP0014X, 2081S0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports Medicine
No207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ143782Medicare PIN