Basic Information
| Provider Information | |||||||||
| NPI: | 1295939692 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MUNIZ | ||||||||
| FirstName: | ELISA | ||||||||
| MiddleName: | IRAIDA | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 675 WATER ST | ||||||||
| Address2: | APT. 14B | ||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100028113 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3053210089 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1650 SELWYN AVE | ||||||||
| Address2: | 6D | ||||||||
| City: | BRONX | ||||||||
| State: | NY | ||||||||
| PostalCode: | 104577626 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7189601412 | ||||||||
| FaxNumber: | 7185185124 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/12/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 244589 | NY | Y | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.