1336219989 NPI number — TSANG DEREK FONG LAU DMD

Table of content: TSANG DEREK FONG LAU DMD (NPI 1336219989)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336219989 NPI number — TSANG DEREK FONG LAU DMD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LAU
Provider First Name:
TSANG DEREK
Provider Middle Name:
FONG
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DMD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
LAU
Provider Other First Name:
DEREK
Provider Other Middle Name:
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1336219989
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1180 ROUTE 46 WEST
Provider Second Line Business Mailing Address:
#209
Provider Business Mailing Address City Name:
PARSIPPANY
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07054
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
973-402-0595
Provider Business Mailing Address Fax Number:
973-402-9177

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1180 ROUTE 46 WEST
Provider Second Line Business Practice Location Address:
#209
Provider Business Practice Location Address City Name:
PARSIPPANY
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07054
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
973-402-0595
Provider Business Practice Location Address Fax Number:
973-402-9177
Provider Enumeration Date:
11/09/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 122300000X , with the licence number:  0473541 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 122300000X , with the licence number: DI20102 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)