Healthcare Provider Details

I. General information

NPI: 1578531190
Provider Name (Legal Business Name): SANTIAGO MUNOZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/09/2006
Last Update Date: 05/15/2023
Certification Date: 05/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1198 LAKEWOOD RD FL 2
TOMS RIVER NJ
08753-2237
US

IV. Provider business mailing address

136 KIMBERBRAE DR
PHOENIXVILLE PA
19460-1615
US

V. Phone/Fax

Practice location:
  • Phone: 856-796-9340
  • Fax: 856-547-0390
Mailing address:
  • Phone: 609-238-7458
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RT0003X
TaxonomyTransplant Hepatology Physician
License NumberMD039763L
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code207RT0003X
TaxonomyTransplant Hepatology Physician
License Number25MA0834100
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: