Basic Information
| Provider Information | |||||||||
| NPI: | 1578531190 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MUNOZ | ||||||||
| FirstName: | SANTIAGO | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 301 LIPPINCOTT DR STE 410 | ||||||||
| Address2: | |||||||||
| City: | MARLTON | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 080534197 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8563550260 | ||||||||
| FaxNumber: | 8563255220 | ||||||||
| Practice Location | |||||||||
| Address1: | 63 KRESSON RD STE 101C | ||||||||
| Address2: | |||||||||
| City: | CHERRY HILL | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 080343200 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8567969340 | ||||||||
| FaxNumber: | 8565470390 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/09/2006 | ||||||||
| LastUpdateDate: | 08/24/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/24/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RI0008X | 25MA08341000 | NJ | N | Allopathic & Osteopathic Physicians | Internal Medicine | Hepatology | 207RI0008X | MD039763L | PA | N | Allopathic & Osteopathic Physicians | Internal Medicine | Hepatology | 207RT0003X | MD039763L | PA | N | Allopathic & Osteopathic Physicians | Internal Medicine | Transplant Hepatology | 207RT0003X | 25MA0834100 | NJ | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Transplant Hepatology |
ID Information
| ID | Type | State | Issuer | Description | 1279946 | 05 | PA | MEDICAID |