Provider Demographics
NPI:1285188235
Name:DA CRUZ, VANESSA P (LPN, CPHT)
Entity Type:Individual
Prefix:
First Name:VANESSA
Middle Name:P
Last Name:DA CRUZ
Suffix:
Gender:F
Credentials:LPN, CPHT
Other - Prefix:
Other - First Name:VANESSA
Other - Middle Name:P
Other - Last Name:DACRUZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LPN, CPHT
Mailing Address - Street 1:241 FERNWOOD TER
Mailing Address - Street 2:
Mailing Address - City:LINDEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07036-4917
Mailing Address - Country:US
Mailing Address - Phone:908-414-7642
Mailing Address - Fax:
Practice Address - Street 1:90 BERGEN ST
Practice Address - Street 2:SUITE 8100
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07103-2425
Practice Address - Country:US
Practice Address - Phone:973-972-7815
Practice Address - Fax:973-972-3767
Is Sole Proprietor?:No
Enumeration Date:2016-08-08
Last Update Date:2016-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NP06761900164W00000X
NJ28RW00532400183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
No183700000XPharmacy Service ProvidersPharmacy Technician