Provider Demographics
NPI:1336219989
Name:LAU, TSANG DEREK FONG (DMD)
Entity Type:Individual
Prefix:
First Name:TSANG DEREK
Middle Name:FONG
Last Name:LAU
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:DR
Other - First Name:DEREK
Other - Middle Name:
Other - Last Name:LAU
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:1180 ROUTE 46 WEST
Mailing Address - Street 2:#209
Mailing Address - City:PARSIPPANY
Mailing Address - State:NJ
Mailing Address - Zip Code:07054
Mailing Address - Country:US
Mailing Address - Phone:973-402-0595
Mailing Address - Fax:973-402-9177
Practice Address - Street 1:1180 ROUTE 46 WEST
Practice Address - Street 2:#209
Practice Address - City:PARSIPPANY
Practice Address - State:NJ
Practice Address - Zip Code:07054
Practice Address - Country:US
Practice Address - Phone:973-402-0595
Practice Address - Fax:973-402-9177
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0473541122300000X
NJDI20102122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist