Provider Demographics
NPI:1891050399
Name:MUNIZ, IRIS (MSED)
Entity Type:Individual
Prefix:MS
First Name:IRIS
Middle Name:
Last Name:MUNIZ
Suffix:
Gender:F
Credentials:MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4822 AVENUE M
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11234-3725
Mailing Address - Country:US
Mailing Address - Phone:917-494-0513
Mailing Address - Fax:347-702-8050
Practice Address - Street 1:4822 AVENUE M
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11234-3325
Practice Address - Country:US
Practice Address - Phone:917-494-0513
Practice Address - Fax:347-702-8050
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-10
Last Update Date:2012-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY174400000X174V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174V00000XOther Service ProvidersClinical Ethicist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY930976396OtherGHI