Provider Demographics
NPI:1679988935
Name:MONTANEZ, VANESSA D (ANP)
Entity Type:Individual
Prefix:
First Name:VANESSA
Middle Name:D
Last Name:MONTANEZ
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1014 MAPLE AVE
Mailing Address - Street 2:
Mailing Address - City:RIDGEFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07657-1009
Mailing Address - Country:US
Mailing Address - Phone:973-249-8100
Mailing Address - Fax:973-249-8110
Practice Address - Street 1:298 PASSAIC STREET
Practice Address - Street 2:PASSAIC PEDIATRICS PA
Practice Address - City:PASSAIC
Practice Address - State:NJ
Practice Address - Zip Code:07055-1009
Practice Address - Country:US
Practice Address - Phone:973-249-8100
Practice Address - Fax:973-249-8110
Is Sole Proprietor?:No
Enumeration Date:2014-06-25
Last Update Date:2014-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00500400363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner