Provider Demographics
NPI:1306317789
Name:MENON REGENERATIVE INSTITUTE LLC
Entity type:Organization
Organization Name:MENON REGENERATIVE INSTITUTE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ADITI
Authorized Official - Middle Name:SEN
Authorized Official - Last Name:MENON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-447-8093
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
Mailing Address - Country:US
Mailing Address - Phone:973-382-5002
Mailing Address - Fax:973-924-0882
Practice Address - Street 1:45 ESSEX STREET, SUITE 202
Practice Address - Street 2:
Practice Address - City:MILLBURN
Practice Address - State:NJ
Practice Address - Zip Code:07041
Practice Address - Country:US
Practice Address - Phone:973-382-5002
Practice Address - Fax:973-924-0882
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-11
Last Update Date:2024-12-16
Deactivation Date:2021-04-08
Deactivation Code:
Reactivation Date:2021-05-24
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty