Provider Demographics
NPI:1801676101
Name:MUNOZ, KEVIN CHRISTOPHER
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:CHRISTOPHER
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 1:6140 LINDEN ST
Mailing Address - Street 2:
Mailing Address - City:RIDGEWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:11385-3323
Mailing Address - Country:US
Mailing Address - Phone:347-570-3543
Mailing Address - Fax:
Practice Address - Street 1:7252 METROPOLITAN AVE
Practice Address - Street 2:
Practice Address - City:MIDDLE VILLAGE
Practice Address - State:NY
Practice Address - Zip Code:11379-2100
Practice Address - Country:US
Practice Address - Phone:718-326-0055
Practice Address - Fax:718-326-5968
Is Sole Proprietor?:No
Enumeration Date:2023-10-03
Last Update Date:2023-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY033549-01235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist