Provider Demographics
NPI:1154290831
Name:LANTIGUA, VANESSA (PMHNP)
Entity type:Individual
Prefix:
First Name:VANESSA
Middle Name:
Last Name:LANTIGUA
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 FRANKLIN AVE
Mailing Address - Street 2:
Mailing Address - City:BELLEVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07109-1543
Mailing Address - Country:US
Mailing Address - Phone:631-836-8963
Mailing Address - Fax:
Practice Address - Street 1:315 MADISON AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10017-5457
Practice Address - Country:US
Practice Address - Phone:646-661-5225
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-11-01
Last Update Date:2025-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY781690363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health