Shoba Menon Md, Pc | |
1866 Wading River Manor Rd Wading River NY 11792-2137 | |
(631) 929-8787 | |
(631) 929-0350 |
Full Name | Shoba Menon Md, Pc |
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Speciality | Internal Medicine |
Location | 1866 Wading River Manor Rd, Wading River, New York |
Authorized Official Name and Position | Shoba Menon (PHYSICIAN) |
Authorized Official Contact | 6319298787 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Shoba Menon Md, Pc P.o. Box 625 Wading River NY 11792-2137 Ph: (631) 929-8787 | Shoba Menon Md, Pc 1866 Wading River Manor Rd Wading River NY 11792-2137 Ph: (631) 929-8787 |
NPI Number | 1659816213 |
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Provider Enumeration Date | 01/05/2017 |
Last Update Date | 04/20/2017 |
Medicare PECOS PAC ID | 4183900970 |
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Medicare Enrollment ID | O20170410001718 |
Identifier | Type | State | Issuer |
---|---|---|---|
1659816213 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207R00000X | Internal Medicine | (New York) | Primary |
Provider Name | Shoba Menon |
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Provider Type | Practitioner - Internal Medicine |
Provider Identifiers | NPI Number: 1154481539 PECOS PAC ID: 6800944315 Enrollment ID: I20090511000063 |
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