Basic Information
| Provider Information | |||||||||
| NPI: | 1295231652 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MUNOZ | ||||||||
| FirstName: | DEMETRIO | ||||||||
| MiddleName: | ANTONIO | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 550 E GENESEE ST STE 200 | ||||||||
| Address2: | |||||||||
| City: | SYRACUSE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 132022124 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3154644363 | ||||||||
| FaxNumber: | 3154646229 | ||||||||
| Practice Location | |||||||||
| Address1: | 550 E GENESEE ST STE 200 | ||||||||
| Address2: | |||||||||
| City: | SYRACUSE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 132022124 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3154644363 | ||||||||
| FaxNumber: | 3154646229 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/04/2018 | ||||||||
| LastUpdateDate: | 07/11/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/11/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 306764 | NY | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
No ID Information.