Provider Demographics
NPI:1588691059
Name:MUNOZ, RICHARD (DPM)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:
Last Name:MUNOZ
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:387 W BLACKWELL ST
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:NJ
Mailing Address - Zip Code:07801-2559
Mailing Address - Country:US
Mailing Address - Phone:973-366-8000
Mailing Address - Fax:973-442-1300
Practice Address - Street 1:387 W BLACKWELL ST
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:NJ
Practice Address - Zip Code:07801-2559
Practice Address - Country:US
Practice Address - Phone:973-366-8000
Practice Address - Fax:973-442-1300
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2019-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MD00143700213ES0103X, 213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJT45209Medicare UPIN
NJ451599Medicare ID - Type Unspecified