Basic Information
| Provider Information | |||||||||
| NPI: | 1447493572 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | JOSE B MUNIN MD PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6045 KENNEDY BLVD | ||||||||
| Address2: | |||||||||
| City: | NORTH BERGEN | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 070473246 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2014539200 | ||||||||
| FaxNumber: | 2018610941 | ||||||||
| Practice Location | |||||||||
| Address1: | 6045 KENNEDY BLVD | ||||||||
| Address2: | |||||||||
| City: | NORTH BERGEN | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 070473246 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2014539200 | ||||||||
| FaxNumber: | 2018610941 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/20/2009 | ||||||||
| LastUpdateDate: | 04/20/2009 | ||||||||
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| AuthorizedOfficialLastName: | MUNIN | ||||||||
| AuthorizedOfficialFirstName: | JOSE | ||||||||
| AuthorizedOfficialMiddleName: | B | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 2014539200 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RG0300X | MA049231 | NJ | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Geriatric Medicine |
No ID Information.