Provider Demographics
NPI:1992247225
Name:MUNIZ, JASON
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:
Last Name:MUNIZ
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 1:414 S SERVICE RD STE 309
Mailing Address - Street 2:
Mailing Address - City:PATCHOGUE
Mailing Address - State:NY
Mailing Address - Zip Code:11772-2254
Mailing Address - Country:US
Mailing Address - Phone:631-949-7824
Mailing Address - Fax:
Practice Address - Street 1:916 DOANE AVE
Practice Address - Street 2:
Practice Address - City:BELLPORT
Practice Address - State:NY
Practice Address - Zip Code:11713-1530
Practice Address - Country:US
Practice Address - Phone:631-949-7824
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-17
Last Update Date:2018-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246XS1301XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist CardiovascularSonography