Provider Demographics
NPI:1578531190
Name:MUNOZ, SANTIAGO (MD)
Entity Type:Individual
Prefix:
First Name:SANTIAGO
Middle Name:
Last Name:MUNOZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:136 KIMBERBRAE DR
Mailing Address - Street 2:
Mailing Address - City:PHOENIXVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19460-1615
Mailing Address - Country:US
Mailing Address - Phone:609-238-7458
Mailing Address - Fax:
Practice Address - Street 1:1198 LAKEWOOD RD FL 2
Practice Address - Street 2:
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08753-2237
Practice Address - Country:US
Practice Address - Phone:856-796-9340
Practice Address - Fax:856-547-0390
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2023-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD039763L207RT0003X, 207RT0003X
NJ25MA0834100207RT0003X, 207RT0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RT0003XAllopathic & Osteopathic PhysiciansInternal MedicineTransplant Hepatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1279946Medicaid
0000027620Medicare ID - Type Unspecified
F04630Medicare UPIN