Healthcare Provider Details

I. General information

NPI: 1962613174
Provider Name (Legal Business Name): LIZ P MUNOZ MD MPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LIZ P KWON MD MPH

II. Dates (important events)

Enumeration Date: 05/28/2007
Last Update Date: 10/15/2020
Certification Date: 10/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

82 HOLLAND ST
ROCHESTER NY
14605
US

IV. Provider business mailing address

82 HOLLAND ST
ROCHESTER NY
14605-2131
US

V. Phone/Fax

Practice location:
  • Phone: 585-423-5800
  • Fax:
Mailing address:
  • Phone: 585-423-5800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number258445
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License Number258445
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number258445
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: