Provider Demographics
NPI:1801267505
Name:MUNOZ, EMMANUEL BAUTISTA
Entity type:Individual
Prefix:MR
First Name:EMMANUEL
Middle Name:BAUTISTA
Last Name:MUNOZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 LOCUST AVE
Mailing Address - Street 2:
Mailing Address - City:DUMONT
Mailing Address - State:NJ
Mailing Address - Zip Code:07628-3517
Mailing Address - Country:US
Mailing Address - Phone:201-384-3418
Mailing Address - Fax:
Practice Address - Street 1:106 LOCUST AVE
Practice Address - Street 2:
Practice Address - City:DUMONT
Practice Address - State:NJ
Practice Address - Zip Code:07628-3517
Practice Address - Country:US
Practice Address - Phone:201-384-3418
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-07
Last Update Date:2015-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY537012-1163W00000X, 163WG0100X, 163WP0000X, 163WS0121X, 163WU0100X, 163WX0800X, 163WX1100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WG0100XNursing Service ProvidersRegistered NurseGastroenterology
No163WP0000XNursing Service ProvidersRegistered NursePain Management
No163WS0121XNursing Service ProvidersRegistered NursePlastic Surgery
No163WU0100XNursing Service ProvidersRegistered NurseUrology
No163WX0800XNursing Service ProvidersRegistered NurseOrthopedic
No163WX1100XNursing Service ProvidersRegistered NurseOphthalmic