NPIMap

Individual provider Active NPI

Ajay Menon, DO

  • Vascular Surgery Physician
  • Brick, NJ
National Provider Identifier
1457843633
Registry record updated Aug 13, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Vascular Surgery PhysicianTaxonomy code 2086S0129X
License
25MB12592900 Issued in NJ
Practice address
425 Jack Martin Blvd
Brick, NJ 08724-7732
Phone
(732) 202-1500
Fax
(732) 202-1058
NPI assigned
Jun 4, 2018
Last updated
Aug 13, 2025By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 13, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X NU
Surgery Physician 208600000X 25MB12592900 NJ
Vascular Surgery Physician 2086S0129X 25MB12592900 NJ Primary

Addresses

Primary practice location

425 Jack Martin Blvd
Brick, NJ 08724-7732

Mailing address

425 Jack Martin Blvd
Brick, NJ 08724-7732

Other practice location 1

475 Seaview Ave
Staten Island, NY 10305-3436
Phone (718) 226-6800

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250731000206 NJ Practitioner - Vascular Surgery 1153838339 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Vascular Surgery
Education
Other, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

425 Jack Martin Blvd
Brick, NJ 08724-7732
Phone (732) 202-1500

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Leg revascularization (restoring blood flow)13

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

State licenses

LicenseStateTypeSpecialty
25MB12592900NJMDSurgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Hackensack Meridian Health Medical Group - Specialty Care PC CurrentSince Sep 1, 2025 Accepting new patients
Hackensack Meridian Health Medical Group - Specialty Care PC CurrentSince Sep 1, 2025 Accepting new patients
Hackensack Meridian Health Medical Group - Complex Care PC Surgery Past Accepting new patients

Locations

30 Prospect Ave
Hackensack, NJ 07601
Phone (201) 488-0066

1944 State Route 33
Neptune, NJ 07753
Phone (732) 776-3787

331 Newman Springs Rd
Ste 220
Red Bank, NJ 07701
Phone (732) 807-0880

425 Jack Martin Blvd
Wall Township, NJ 08724
Phone (732) 840-2200

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/IHJHBD

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 5

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1528070400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1755043200000",
    "number": "1457843633",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "425 JACK MARTIN BLVD",
            "city": "BRICK",
            "state": "NJ",
            "postal_code": "087247732"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "425 JACK MARTIN BLVD",
            "city": "BRICK",
            "state": "NJ",
            "postal_code": "087247732",
            "telephone_number": "732-202-1500",
            "fax_number": "732-202-1058"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "475 Seaview Ave",
            "address_purpose": "LOCATION",
            "city": "Staten Island",
            "state": "NY",
            "postal_code": "103053436",
            "country_code": "US",
            "telephone_number": "718-226-6800",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MENON",
        "first_name": "AJAY",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-06-04",
        "last_updated": "2025-08-13",
        "certification_date": "2025-08-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "NJ",
            "license": "25MB12592900",
            "primary": false
        },
        {
            "code": "2086S0129X",
            "taxonomy_group": "",
            "desc": "Surgery, Vascular Surgery",
            "state": "NJ",
            "license": "25MB12592900",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Brick, NJ

Sources for this page

Verify at the official NPI Registry.