Provider Demographics
NPI:1720113095
Name:CAMPOS-MUNOZ, MAGALY (MD)
Entity Type:Individual
Prefix:DR
First Name:MAGALY
Middle Name:
Last Name:CAMPOS-MUNOZ
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 1:824 ELIZABETH AVE
Mailing Address - Street 2:
Mailing Address - City:ELIZABETH
Mailing Address - State:NJ
Mailing Address - Zip Code:07201-2709
Mailing Address - Country:US
Mailing Address - Phone:908-352-0103
Mailing Address - Fax:908-352-9134
Practice Address - Street 1:824 ELIZABETH AVE
Practice Address - Street 2:
Practice Address - City:ELIZABETH
Practice Address - State:NJ
Practice Address - Zip Code:07201-2709
Practice Address - Country:US
Practice Address - Phone:908-352-0103
Practice Address - Fax:908-352-9134
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-23
Last Update Date:2012-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA062664002084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0056197Medicaid
NJ0056197Medicaid