Provider Demographics
NPI:1770643959
Name:LANEZ, CARMENCITA T (MD)
Entity Type:Individual
Prefix:
First Name:CARMENCITA
Middle Name:T
Last Name:LANEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201-205 NEW BRUNSWICK AVE
Mailing Address - Street 2:
Mailing Address - City:HOPELAWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08861-2368
Mailing Address - Country:US
Mailing Address - Phone:732-205-1610
Mailing Address - Fax:732-442-4545
Practice Address - Street 1:201-205 NEW BRUNSWICK AVE
Practice Address - Street 2:
Practice Address - City:HOPELAWN
Practice Address - State:NJ
Practice Address - Zip Code:08861-2368
Practice Address - Country:US
Practice Address - Phone:732-205-1610
Practice Address - Fax:732-442-4545
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-11
Last Update Date:2019-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA043917002084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2020201Medicaid
NJ2020201Medicaid
D06615Medicare UPIN