Healthcare Provider Details

I. General information

NPI: 1295939692
Provider Name (Legal Business Name): ELISA IRAIDA MUNIZ M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/12/2007
Last Update Date: 03/21/2024
Certification Date: 03/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1225 MORRIS PARK AVE
BRONX NY
10461-1949
US

IV. Provider business mailing address

675 WATER ST APT. 14B
NEW YORK NY
10002-8113
US

V. Phone/Fax

Practice location:
  • Phone: 718-430-3914
  • Fax:
Mailing address:
  • Phone: 305-321-0089
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number244589
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code2080P0006X
TaxonomyDevelopmental - Behavioral Pediatrics Physician
License Number244589
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: