Provider Demographics
NPI:1295939692
Name:MUNIZ, ELISA IRAIDA (MD)
Entity type:Individual
Prefix:
First Name:ELISA
Middle Name:IRAIDA
Last Name:MUNIZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:675 WATER ST
Mailing Address - Street 2:APT. 14B
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10002-8113
Mailing Address - Country:US
Mailing Address - Phone:305-321-0089
Mailing Address - Fax:
Practice Address - Street 1:1225 MORRIS PARK AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10461-1949
Practice Address - Country:US
Practice Address - Phone:718-430-3914
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-12
Last Update Date:2024-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY244589208000000X, 2080P0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0006XAllopathic & Osteopathic PhysiciansPediatricsDevelopmental - Behavioral Pediatrics
No208000000XAllopathic & Osteopathic PhysiciansPediatrics