Healthcare Provider Details

I. General information

NPI: 1649858507
Provider Name (Legal Business Name): GABRIEL MUNOZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/31/2021
Last Update Date: 07/05/2024
Certification Date: 07/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14 GROVE ST
MIDDLETOWN NY
10940-4806
US

IV. Provider business mailing address

2570 ROUTE 9W STE 10
CORNWALL NY
12518-1370
US

V. Phone/Fax

Practice location:
  • Phone: 845-343-2273
  • Fax:
Mailing address:
  • Phone: 845-220-3100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number328309
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: