Provider Demographics
NPI:1851431019
Name:LANTZY, PATRICK (PHD)
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:
Last Name:LANTZY
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 26
Mailing Address - Street 2:
Mailing Address - City:CHESTER
Mailing Address - State:NJ
Mailing Address - Zip Code:07930-0026
Mailing Address - Country:US
Mailing Address - Phone:973-601-0100
Mailing Address - Fax:973-338-2211
Practice Address - Street 1:200 VALLEY RD
Practice Address - Street 2:SUITE 301
Practice Address - City:MT ARLINGTON
Practice Address - State:NJ
Practice Address - Zip Code:07856-1320
Practice Address - Country:US
Practice Address - Phone:973-601-0100
Practice Address - Fax:973-338-2211
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2008-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPA PS-005396-L103TB0200X
NJSI 03721103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ028097Medicare PIN