Provider Demographics
NPI:1861661704
Name:MENKES, LEO (DO)
Entity Type:Individual
Prefix:DR
First Name:LEO
Middle Name:
Last Name:MENKES
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 1:66 WEST GILBERT STREET
Mailing Address - Street 2:
Mailing Address - City:RED BANK
Mailing Address - State:NJ
Mailing Address - Zip Code:07701-4918
Mailing Address - Country:US
Mailing Address - Phone:732-212-0060
Mailing Address - Fax:732-212-0061
Practice Address - Street 1:268 MARTIN LUTHER KING BLVD.
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07102-0000
Practice Address - Country:US
Practice Address - Phone:973-877-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-25
Last Update Date:2021-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY243528207R00000X, 208D00000X
NJ25MB08679900207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJP00829596OtherRR MEDICARE
NJ0223336Medicaid
NJ3768498000OtherAMERIHEALTH
NJP00829596OtherRR MEDICARE
NJ176015SN3Medicare PIN