Provider Demographics
NPI:1295733715
Name:LANTZ, MELINDA S (MD)
Entity type:Individual
Prefix:DR
First Name:MELINDA
Middle Name:S
Last Name:LANTZ
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 1:155 E 29TH ST
Mailing Address - Street 2:SUITE 9A
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-8173
Mailing Address - Country:US
Mailing Address - Phone:212-420-2457
Mailing Address - Fax:212-779-9829
Practice Address - Street 1:10 NATHAN D PERLMAN PL
Practice Address - Street 2:6 KARPAS 40
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-3851
Practice Address - Country:US
Practice Address - Phone:212-420-2457
Practice Address - Fax:212-844-7659
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-08
Last Update Date:2008-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1725612084P0802X, 2084P0800X, 2084P0805X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0802XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction Psychiatry
No2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01585693Medicaid
NY00637Medicare ID - Type UnspecifiedGHI
NYF28659Medicare UPIN
NY33H451Medicare ID - Type UnspecifiedEMPIREBCBS